MEDICARE: EVOLVE BEHAVIORAL MEDICINE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251V00000X	Voluntary or Charitable Agency
2	261Q00000X	Clinic/Center
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
4	261QM1300X	Multi-Specialty Clinic/Center
5	261QM2500X	Medical Specialty Clinic/Center
6	261QR1100X	Research Clinic/Center
7	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1982472049
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOLVE BEHAVIORAL MEDICINE LLC

Provider Business Mailing Address
First Line	:	8348 LITTLE RD
Second Line	:	PMB 138
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34654-6358
Country	:	US
Telephone Number	:	813-384-8521
Fax Number	:

Provider Business Practice Location Address
First Line	:	16614 N DALE MABRY HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-1400
Country	:	US
Telephone Number	:	813-384-8521
Fax Number	:	813-678-2768

Authorized Official
Title or Position	:	OWNER/MEDICAL DIRECTOR
Name	:	DR. CUONG TON
Credential	:	MD
Telephone Number	:	813-384-8521

Provider Enumeration Date	:	12/18/2023
Last Update Date	:	12/18/2023

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