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EVERGREEN BEHAVIORAL HEALTH, PC

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Company Details

Legal Name: EVERGREEN BEHAVIORAL HEALTH, PC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL SERVICE CORPORATION
Category: DOMESTIC ENTITY
Status: Voluntarily Dissolved
Formation/ Registration Date: August 1st 2011
Date of Dissolution: December 7th 2020
Expiration date: 31 Aug 2020
UBI Number: 603 131 740
ZIP code: 98686
City: Vancouver
County: CLARK
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 2621 NE 134TH ST #340, VANCOUVER, WA, 98686, UNITED STATES
Supporting healthcare providers fighting with COVID-19: $5,616

Contact Details

E-Mail: JILL@EVERGREENBEHAVIORALHEALTH.COM

Nature of Business

Health Care, Social Assistance & Service Organization, Professional, Scientific & Technical Services

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Registered Agent Information

Name Role Address
JILL FANCHER Registered Agent 2621 NE 134TH ST, #340, VANCOUVER, WA, 98686-0000, UNITED STATES

Key Officers & Management

Name Role Address
JILL FANCHER Governing Person 2621 NE 134TH ST STE 340, VANCOUVER, WA, 98686-3036, UNITED STATES

National Provider Identifier

NPI Number:
1205146776

Authorized Person:

Name:
JILL B FANCHER
Role:
CLINIC DIRECTOR/OWNER
Phone:

Taxonomy:

Selected Taxonomy:
101YM0800X - Mental Health Counselor
Is Primary:
No
Selected Taxonomy:
1041C0700X - Clinical Social Worker
Is Primary:
No
Selected Taxonomy:
225700000X - Massage Therapist
Is Primary:
No
Selected Taxonomy:
103TC0700X - Clinical Psychologist
Is Primary:
Yes

Contacts:

Fax:
8773430535

Trademarks

Serial Number:
85678801
Mark:
MASTERING PAIN
Status:
Registration cancelled because registrant did not file an acceptable d...
Mark Type:
Service Mark
Application Filing Date:
2012-07-17
Mark Drawing Type:
4 - STANDARD CHARACTER MARK
Mark Literal Elements:
MASTERING PAIN

Goods And Services

For:
Behavioral health services
First Use:
2009-11-06
International Classes:
044 - Primary Class
Class Status:
SECTION 8 - CANCELLED
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