Healthcare Provider Details

I. General information

NPI: 1861237307
Provider Name (Legal Business Name): EVOLVE COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 S BRENTWOOD BLVD STE 555
SAINT LOUIS MO
63117-1265
US

IV. Provider business mailing address

1034 S BRENTWOOD BLVD STE 555
SAINT LOUIS MO
63117-1265
US

V. Phone/Fax

Practice location:
  • Phone: 314-912-2131
  • Fax: 314-784-5802
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH SHEA
Title or Position: OWNER/THERAPIST
Credential: LPC
Phone: 314-912-2131