EVERGREEN PSYCHOLOGY, PLLC — NPI 1174370779 (Licensed & Credentialed Behavioral Health & Social Service Providers

CMS-1500 Box 24J / 33a • NPI

1174370779

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

103TC1900X (CMS 62)

Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Counseling

Box 32 Service Location & ZIP+4

18 TOON LN, LEE, NH, 03861-6507

✓ 9-Digit EDI 837 ZIP+4 (03861-6507)

Practice Phone & Referral Fax

(802) 448-0224

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1174370779 (EVERGREEN PSYCHOLOGY, PLLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1174370779` (NPI-2 Organization / Facility)
Provider / Legal Name	EVERGREEN PSYCHOLOGY, PLLC
Plain-English Specialty	Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Counseling NUCC Code: `103TC1900X` (Psychologist, Counseling)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	18 TOON LN, LEE, NH, 03861-6507
Practice Telephone / Fax	Tel: (802) 448-0224
Administrative Mailing Address	18 TOON LN, LEE, NH, 03861-6507
Enumeration & Last Sync	Enumerated: 2024-05-01 \| CMS Record Updated: 2024-05-01
Authorized Official	CECILE DESMOND (Owner)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

18 TOON LN, LEE, NH, 03861-6507

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Plain-English Taxonomy & CMS Crosswalk (103TC1900X)

What Does Taxonomy Code 103TC1900X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 103TC1900X translates to:
"Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Counseling"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 62 (Psychologist, Clinical)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Psychologist, Counseling for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (EVERGREEN PSYCHOLOGY, PLLC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`103TC1900X` — Psychologist, Counseling Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Counseling	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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EVERGREEN PSYCHOLOGY, PLLC (NPI #1174370779)