Provider Demographics
NPI:1164187696
Name:EVOLVE MENTAL HEALTH & WELLNESS SOLUTIONS
Entity Type:Organization
Organization Name:EVOLVE MENTAL HEALTH & WELLNESS SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOZO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:907-947-5514
Mailing Address - Street 1:17155 AVOCET DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97707-2399
Mailing Address - Country:US
Mailing Address - Phone:907-947-5514
Mailing Address - Fax:
Practice Address - Street 1:63220 SILVIS RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-9743
Practice Address - Country:US
Practice Address - Phone:541-280-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-31
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty