MEDICARE: EVOLVE THERAPY AND WELLNESS

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1417739418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOLVE THERAPY AND WELLNESS

Provider Business Mailing Address
First Line	:	104 CUMBERLAND DR
Second Line	:
City	:	SOMERSET
State	:	KY
Zip	:	42503-8006
Country	:	US
Telephone Number	:	606-416-8069
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 CUMBERLAND DR
Second Line	:
City	:	SOMERSET
State	:	KY
Zip	:	42503-8006
Country	:	US
Telephone Number	:	606-416-8069
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DEANNA PHILLIPS
Credential	:	LCSW
Telephone Number	:	606-416-8069

Provider Enumeration Date	:	10/16/2023
Last Update Date	:	05/27/2026

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