Healthcare Provider Details

I. General information

NPI: 1861261943
Provider Name (Legal Business Name): EVOLVE LIFE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2023
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 E BASELINE RD STE 102 #2
TEMPE AZ
85283-1269
US

IV. Provider business mailing address

111 E BETH DR
PHOENIX AZ
85042-7657
US

V. Phone/Fax

Practice location:
  • Phone: 602-579-1711
  • Fax:
Mailing address:
  • Phone: 602-579-1711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANYE CARSON
Title or Position: OWNER
Credential:
Phone: 602-579-1711