Evergreen Therapy LLC
Clinic/Center, Adult Mental Health in Hattiesburg, MS. Organization (NPI-2).
NPI number1629957626
StatusActive
Last updated in NPPESSep 2, 2025
Details
- NPI
- 1629957626
- Entity type
- Organization (NPI-2)
- Legal business name
- Evergreen Therapy LLC
- Organization subpart
- No
- Enumeration date
- Sep 2, 2025
- Certification date
- Sep 2, 2025
- Last updated
- Sep 2, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0850X | Clinic/Center, Adult Mental Health | – | – | Yes |
Practice location
105 N 40th AveHattiesburg, MS 39401-6606
Phone 769-390-7929
Mailing address
103 Fox TerHattiesburg, MS 39402-1813
Phone 601-408-5946
Authorized official
Victoria Lauren Alexander
Counselor/Owner
6014085946
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