Provider Demographics
NPI:1013046853
Name:EVOLVE COUNSELING AND CONSULTATION, PLLC
Entity Type:Organization
Organization Name:EVOLVE COUNSELING AND CONSULTATION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW, LCDC
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:TANTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-562-3709
Mailing Address - Street 1:2323 S SHEPHERD DR
Mailing Address - Street 2:SUITE 1012
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-7019
Mailing Address - Country:US
Mailing Address - Phone:713-562-3709
Mailing Address - Fax:713-520-1415
Practice Address - Street 1:2323 S SHEPHERD DR
Practice Address - Street 2:SUITE 1012
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-7019
Practice Address - Country:US
Practice Address - Phone:713-562-3709
Practice Address - Fax:713-520-1415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8011101YA0400X
TX360571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty