Provider Demographics
NPI:1669026324
Name:EVOLVE THERAPY LLC
Entity Type:Organization
Organization Name:EVOLVE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PETERGAY
Authorized Official - Middle Name:
Authorized Official - Last Name:STERLING
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:904-385-9240
Mailing Address - Street 1:786 BLANDING BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-6728
Mailing Address - Country:US
Mailing Address - Phone:904-385-9240
Mailing Address - Fax:
Practice Address - Street 1:786 BLANDING BLVD STE 120
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-6728
Practice Address - Country:US
Practice Address - Phone:904-385-9240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty