MEDICARE: EVOLVE MENTAL HEALTH & WELLNESS SOLUTIONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1164187696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOLVE MENTAL HEALTH & WELLNESS SOLUTIONS

Provider Business Mailing Address
First Line	:	17155 AVOCET DR
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97707-2399
Country	:	US
Telephone Number	:	907-947-5514
Fax Number	:

Provider Business Practice Location Address
First Line	:	63220 SILVIS RD
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-9743
Country	:	US
Telephone Number	:	541-280-4100
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER/OWNER
Name	:	DR. DEANNA MOZO
Credential	:	PHD
Telephone Number	:	907-947-5514

Provider Enumeration Date	:	10/31/2021
Last Update Date	:	04/03/2023

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Directions to “EVOLVE MENTAL HEALTH & WELLNESS SOLUTIONS ” Practice Location

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