MEDICARE: EVOLVE COUNSELING, LLC

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	:	1477172054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOLVE COUNSELING, LLC

Provider Business Mailing Address
First Line	:	808 REVERE RUN DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-4448
Country	:	US
Telephone Number	:	859-279-4462
Fax Number	:	859-203-0795

Provider Business Practice Location Address
First Line	:	80 CODELL DR STE 220
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1178
Country	:	US
Telephone Number	:	859-279-4462
Fax Number	:	859-203-0795

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	CARLA CASSADA LEMON
Credential	:	LCSW
Telephone Number	:	859-279-4462

Provider Enumeration Date	:	04/13/2020
Last Update Date	:	04/13/2020

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