Healthcare Provider Details

I. General information

NPI: 1558271395
Provider Name (Legal Business Name): EVOLVE BEHAVIORAL HEALTH AND THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CHRISTINA RD
RAYMOND NH
03077-1285
US

IV. Provider business mailing address

35 MANCHESTER RD STE 11A
DERRY NH
03038-3065
US

V. Phone/Fax

Practice location:
  • Phone: 603-241-6758
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KATIE LYN O'DONNELL
Title or Position: OWNER
Credential: LICSW
Phone: 603-241-6758