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General NPI Number Information
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NPI Number | 1245997832
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Entity Type | Organization
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Legal Business Name | EVOLVE FAMILY THERAPY LLC
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Dates
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Enumeration Date | 11/18/2021
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 333 N RANDALL RD # 105-B
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City | ST CHARLES
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State | IL
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Zip | 60174-1573
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Country | US
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Telephone | 845-857-7840
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Fax |
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Provider Business Mailing Address
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Address Line | 333 N RANDALL RD STE 105B
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City | ST CHARLES
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State | IL
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Zip | 60174-1561
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Country | US
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Telephone | 847-857-7840
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | BONNIE MCDANIEL
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Credential |
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Telephone | 847-857-7840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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