Provider Demographics
NPI:1073187860
Name:EVOLUTION COUNSELING
Entity Type:Organization
Organization Name:EVOLUTION COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:CHARLIE
Authorized Official - Last Name:KELNER
Authorized Official - Suffix:
Authorized Official - Credentials:LMAC LPCC
Authorized Official - Phone:701-665-3263
Mailing Address - Street 1:1028 4TH ST NE
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-2702
Mailing Address - Country:US
Mailing Address - Phone:701-665-3263
Mailing Address - Fax:
Practice Address - Street 1:413 4TH ST NE STE 1
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-2542
Practice Address - Country:US
Practice Address - Phone:701-665-3263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-17
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health