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General NPI Number Information
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NPI Number | 1477235760
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Entity Type | Organization
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Legal Business Name | EVOLVE MENTAL HEALTH
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Dates
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Enumeration Date | 08/04/2023
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Last Update Date | 08/04/2023
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Provider Practice Location Address
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Address Line | 428 MINNESOTA ST UNIT 500
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City | SAINT PAUL
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State | MN
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Zip | 55101-2666
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Country | US
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Telephone | 651-565-7768
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Fax |
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Provider Business Mailing Address
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Address Line | 428 MINNESOTA ST UNIT 500
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City | SAINT PAUL
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State | MN
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Zip | 55101-2666
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | ETHAN HAMILTON
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Credential | APRN, CNP, PMHNP-BC
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Telephone | 651-565-7768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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