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General NPI Number Information
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NPI Number | 1861261943
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Entity Type | Organization
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Legal Business Name | EVOLVE LIFE SERVICES
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Dates
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Enumeration Date | 12/29/2023
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Last Update Date | 01/23/2024
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Provider Practice Location Address
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Address Line | 209 E BASELINE RD STE 102 #2
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City | TEMPE
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State | AZ
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Zip | 85283-1269
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Country | US
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Telephone | 602-579-1711
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Fax |
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Provider Business Mailing Address
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Address Line | 111 E BETH DR
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City | PHOENIX
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State | AZ
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Zip | 85042-7657
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Country | US
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Telephone | 602-579-1711
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEPHANYE CARSON
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Credential |
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Telephone | 602-579-1711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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