Healthcare Provider Details

I. General information

NPI: 1184389058
Provider Name (Legal Business Name): EVOLVE MENTAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 50TH ST
WEST DES MOINES IA
50266-1705
US

IV. Provider business mailing address

8913 HIGHLAND OAKS DR
JOHNSTON IA
50131-2225
US

V. Phone/Fax

Practice location:
  • Phone: 515-992-2141
  • Fax: 515-895-1130
Mailing address:
  • Phone: 515-770-4804
  • Fax: 515-895-1130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMANDA MARIA LANTOW
Title or Position: PSYCHIATRIC NURSE PRACTITIONER
Credential: PMHNP-BC
Phone: 515-992-2141