Healthcare Provider Details

I. General information

NPI: 1023929858
Provider Name (Legal Business Name): EVANSTON COLLABORATIVE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 YELLOW CREEK RD STE 302
EVANSTON WY
82930-5236
US

IV. Provider business mailing address

75 YELLOW CREEK RD STE 302
EVANSTON WY
82930-5236
US

V. Phone/Fax

Practice location:
  • Phone: 402-898-1113
  • Fax:
Mailing address:
  • Phone: 307-288-0135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHEENA COLE
Title or Position: DIRECTOR OF PROVIDER SERVICES
Credential: BSHA
Phone: 402-898-1113