Healthcare Provider Details

I. General information

NPI: 1043174501
Provider Name (Legal Business Name): EVOLVING WISDOM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4956 N 33RD CT
HOLLYWOOD FL
33021-2363
US

IV. Provider business mailing address

4956 N 33RD CT
HOLLYWOOD FL
33021-2363
US

V. Phone/Fax

Practice location:
  • Phone: 305-794-1717
  • Fax:
Mailing address:
  • Phone: 305-794-1717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: EVELYN GUTTMAN
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential: LMHC
Phone: 305-794-1717