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NPI Code Detail

MEDICARE: EVOLVE COUNSELING SERVICES LLC

MEDICARE: EVOLVE COUNSELING SERVICES 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
1261QM0850XAdult Mental Health Clinic/CenterLPC.0006480CO

General Provider Information

NPI Number : 1639667652
Entity Type Code : Organization
Provider Name (Legal Business Name) : EVOLVE COUNSELING SERVICES LLC
Provider Business Mailing Address
First Line : 2601 S LEMAY AVE
Second Line : STE. 7 #152
City : FORT COLLINS
State : CO
Zip : 80525-2298
Country : US
Telephone Number : 970-232-9339
Fax Number : 970-232-9367
Provider Business Practice Location Address
First Line : 1136 E. STUART
Second Line : BLDG. 4 STE. 101
City : FORT COLLINS
State : CO
Zip : 80525
Country : US
Telephone Number : 970-232-9339
Fax Number : 970-232-9367
Authorized Official
Title or Position : OWNER
Name : LINDSEY LEE PHILLIPS
Credential : LPC
Telephone Number : 719-440-5475
Provider Enumeration Date : 04/25/2018
Last Update Date : 04/25/2018

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Directions to “EVOLVE COUNSELING SERVICES LLC ” Practice Location

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