=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215804265
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVOLVE MENTAL HEALTH P C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2025
-----------------------------------------------------
Last Update Date | 12/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 575 SKYWAY CT
-----------------------------------------------------
City | MARTINSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46151-7220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-739-9481
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 575 SKYWAY CT
-----------------------------------------------------
City | MARTINSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46151-7220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GABRIELA STANLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 317-739-9481
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------