Healthcare Provider Details

I. General information

NPI: 1083299622
Provider Name (Legal Business Name): EVOLVE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 N LEAVITT RD
AMHERST OH
44001-1131
US

IV. Provider business mailing address

510 N LEAVITT RD
AMHERST OH
44001-1131
US

V. Phone/Fax

Practice location:
  • Phone: 440-644-0745
  • Fax:
Mailing address:
  • Phone: 440-644-0745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: HEATHER SNIEZEK
Title or Position: OWNER
Credential: LPCCS
Phone: 440-644-0745