Provider Demographics
NPI:1083308647
Name:EVOLVE HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:EVOLVE HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEELING
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:480-440-3116
Mailing Address - Street 1:1490 S PRICE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-6606
Mailing Address - Country:US
Mailing Address - Phone:480-440-3116
Mailing Address - Fax:
Practice Address - Street 1:1490 S PRICE RD STE 101
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-6606
Practice Address - Country:US
Practice Address - Phone:480-440-3116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)