Provider Demographics
NPI:1437711157
Name:EVOLUTION THERAPY AND COUNSELING LLC
Entity Type:Organization
Organization Name:EVOLUTION THERAPY AND COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:702-461-0379
Mailing Address - Street 1:50 COROLLA CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-5567
Mailing Address - Country:US
Mailing Address - Phone:703-461-0379
Mailing Address - Fax:
Practice Address - Street 1:9550 S EASTERN AVE STE 220
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-8045
Practice Address - Country:US
Practice Address - Phone:702-494-8085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-02
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty