MEDICARE: EVOLVE THERAPY COLLECTIVE LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1780539676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOLVE THERAPY COLLECTIVE LLC

Provider Business Mailing Address
First Line	:	4404 MEADOWS AVE
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-8689
Country	:	US
Telephone Number	:	947-225-7654
Fax Number	:

Provider Business Practice Location Address
First Line	:	4404 MEADOWS AVE
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-8689
Country	:	US
Telephone Number	:	947-225-7654
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOSHUA JAMES SHILLING
Credential	:	SHILLING
Telephone Number	:	947-225-7654

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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