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General NPI Number Information
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NPI Number | 1225429350
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Entity Type | Organization
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Legal Business Name | EVOLVE COUNSELING & WELLNESS
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Dates
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Enumeration Date | 02/11/2015
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Last Update Date | 02/11/2015
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Provider Practice Location Address
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Address Line | 53 W JACKSON BLVD SUITE 1119
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City | CHICAGO
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State | IL
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Zip | 60604-3606
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Country | US
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Telephone | 312-340-9511
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Fax |
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Provider Business Mailing Address
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Address Line | 53 W JACKSON BLVD SUITE 1119
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City | CHICAGO
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State | IL
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Zip | 60604-3606
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Country | US
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Telephone | 312-340-9511
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Fax |
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Authorized Official
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Title or Position | FOUNDER/THERAPIST
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Name | ALISON MORAN
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Credential |
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Telephone | 312-340-9511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 180007746
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License Number State | IL
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