Provider Demographics
NPI:1073289674
Name:EVOLVE THERAPEUTIC WELLNESS CENTER
Entity Type:Organization
Organization Name:EVOLVE THERAPEUTIC WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROBIN
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:806-252-3421
Mailing Address - Street 1:3330 70TH ST STE 115
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-6136
Mailing Address - Country:US
Mailing Address - Phone:806-252-3421
Mailing Address - Fax:
Practice Address - Street 1:3330 70TH ST STE 115
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-6136
Practice Address - Country:US
Practice Address - Phone:806-252-3421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty