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General NPI Number Information
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NPI Number | 1982472049
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Entity Type | Organization
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Legal Business Name | EVOLVE BEHAVIORAL MEDICINE LLC
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Dates
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Enumeration Date | 12/18/2023
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Last Update Date | 12/18/2023
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Provider Practice Location Address
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Address Line | 16614 N DALE MABRY HWY
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City | TAMPA
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State | FL
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Zip | 33618-1400
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Country | US
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Telephone | 813-384-8521
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Fax | 813-678-2768
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Provider Business Mailing Address
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Address Line | 8348 LITTLE RD PMB 138
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City | NEW PORT RICHEY
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State | FL
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Zip | 34654-6358
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Country | US
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Telephone | 813-384-8521
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Fax |
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Authorized Official
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Title or Position | OWNER/MEDICAL DIRECTOR
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Name | DR. CUONG TON
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Credential | MD
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Telephone | 813-384-8521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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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 | 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 #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QR1100X
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Taxonomy Name | Research Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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