MEDICARE: EVOLVE MENTAL HEALTH SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1598480469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOLVE MENTAL HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	675 WYOMING AVE STE D
Second Line	:
City	:	KINGSTON
State	:	PA
Zip	:	18704-3831
Country	:	US
Telephone Number	:	570-288-4205
Fax Number	:	570-288-4889

Provider Business Practice Location Address
First Line	:	675 WYOMING AVE STE D
Second Line	:
City	:	KINGSTON
State	:	PA
Zip	:	18704-3831
Country	:	US
Telephone Number	:	570-288-4205
Fax Number	:	570-288-4889

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	ALYSSA ZELSNACK
Credential	:	LPC
Telephone Number	:	570-288-4205

Provider Enumeration Date	:	10/04/2022
Last Update Date	:	02/03/2026

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