Provider Demographics
NPI:1508593161
Name:EVOLVERE PSYCHOLOGY INCORPORATED
Entity Type:Organization
Organization Name:EVOLVERE PSYCHOLOGY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEAGAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GUENTHER
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:513-503-6356
Mailing Address - Street 1:2801 TOWNSGATE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3034
Mailing Address - Country:US
Mailing Address - Phone:424-334-9874
Mailing Address - Fax:
Practice Address - Street 1:2801 TOWNSGATE RD STE 102
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-3034
Practice Address - Country:US
Practice Address - Phone:424-334-9874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-04
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)