Provider Demographics
NPI:1124997499
Name:EVOLVE BEHAVIORAL AND WELLNESS
Entity type:Organization
Organization Name:EVOLVE BEHAVIORAL AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAVERSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-257-3500
Mailing Address - Street 1:5867 WHIPPOORWILL CIR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-6509
Mailing Address - Country:US
Mailing Address - Phone:954-512-9001
Mailing Address - Fax:
Practice Address - Street 1:5867 WHIPPOORWILL CIR
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:FL
Practice Address - Zip Code:33470-6509
Practice Address - Country:US
Practice Address - Phone:954-512-9001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-04
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty