Healthcare Provider Details

I. General information

NPI: 1538622675
Provider Name (Legal Business Name): EVNSQ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2019
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5170 S HIGHLAND DR
HOLLADAY UT
84117-7048
US

IV. Provider business mailing address

5170 S HIGHLAND DR
HOLLADAY UT
84117-7048
US

V. Phone/Fax

Practice location:
  • Phone: 801-669-3967
  • Fax:
Mailing address:
  • Phone: 801-669-3967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: BRIANNA JONES-WHELAN
Title or Position: COO
Credential:
Phone: 801-244-8238