Healthcare Provider Details

I. General information

NPI: 1780596247
Provider Name (Legal Business Name): EVOLUTION THERAPY GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5306 BALLARD AVE NW STE 320
SEATTLE WA
98107-4366
US

IV. Provider business mailing address

5306 BALLARD AVE NW STE 320
SEATTLE WA
98107-4366
US

V. Phone/Fax

Practice location:
  • Phone: 206-953-4066
  • Fax:
Mailing address:
  • Phone:
  • Fax: 206-953-4066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JENNIFER PALMER
Title or Position: OWNER
Credential: LMHC
Phone: 206-953-4066