Healthcare Provider Details

I. General information

NPI: 1538014386
Provider Name (Legal Business Name): EVOLUTION HEALTHCARE PROFESSIONAL COUNSELING AND FAMILY THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S KRAEMER BLVD STE 220
PLACENTIA CA
92870-6110
US

IV. Provider business mailing address

101 S KRAEMER BLVD STE 220
PLACENTIA CA
92870-6110
US

V. Phone/Fax

Practice location:
  • Phone: 909-257-8287
  • Fax:
Mailing address:
  • Phone: 949-257-2249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL GALLESE
Title or Position: CEO
Credential:
Phone: 949-257-2249