MEDICARE: EVOLUTION FROM WITHIN, P.C.

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	:	1477892339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOLUTION FROM WITHIN, P.C.

Provider Business Mailing Address
First Line	:	5758 N MESA ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-5427
Country	:	US
Telephone Number	:	347-623-4483
Fax Number	:

Provider Business Practice Location Address
First Line	:	5758 N MESA ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-5427
Country	:	US
Telephone Number	:	347-623-4483
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LESLEY ANN BUCK
Credential	:	LCSW
Telephone Number	:	347-623-4483

Provider Enumeration Date	:	02/12/2013
Last Update Date	:	02/12/2013

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