Provider Demographics
NPI:1972262699
Name:EVOLUTION PSYCHIATRIC AND MENTAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:EVOLUTION PSYCHIATRIC AND MENTAL HEALTH SERVICES, LLC
Other - Org Name:EVOLUTION HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:AIJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP
Authorized Official - Phone:352-575-3600
Mailing Address - Street 1:1204 NW 69TH TER STE B
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-3139
Mailing Address - Country:US
Mailing Address - Phone:352-575-3600
Mailing Address - Fax:352-559-0495
Practice Address - Street 1:1204 NW 69TH TER STE B
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3139
Practice Address - Country:US
Practice Address - Phone:352-575-3600
Practice Address - Fax:352-641-9592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-09
Last Update Date:2024-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty