Provider Demographics
NPI:1649813858
Name:EVOLVE BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:EVOLVE BEHAVIORAL HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF TECHNOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-880-3990
Mailing Address - Street 1:3331 E RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-1457
Mailing Address - Country:US
Mailing Address - Phone:239-880-3990
Mailing Address - Fax:
Practice Address - Street 1:3331 E RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-1457
Practice Address - Country:US
Practice Address - Phone:239-880-3990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-21
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility