Healthcare Provider Details

I. General information

NPI: 1275825796
Provider Name (Legal Business Name): EVOLVE PSYCHOTHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N MICHIGAN AVE SUITE 760
CHICAGO IL
60601-7511
US

IV. Provider business mailing address

155 NORTH MICHIGAN AVE SUITE 760
CHICAGO IL
60601
US

V. Phone/Fax

Practice location:
  • Phone: 224-639-6909
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.006224
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149006137
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149012341
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149002414
License Number StateIL

VIII. Authorized Official

Name: DR. JILL SCHOENEMAN-PARKER
Title or Position: OWNER
Credential: PSY.D.
Phone: 224-639-6909