Provider Demographics
NPI:1740955210
Name:EVOLVE BEHAVIOR THERAPY SERVICES LLC
Entity type:Organization
Organization Name:EVOLVE BEHAVIOR THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEEHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-795-1755
Mailing Address - Street 1:1910 PARK MEADOWS DR STE 103
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3830
Mailing Address - Country:US
Mailing Address - Phone:239-260-4218
Mailing Address - Fax:239-900-1283
Practice Address - Street 1:1910 PARK MEADOWS DR STE 103
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3830
Practice Address - Country:US
Practice Address - Phone:239-260-4218
Practice Address - Fax:239-900-1283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-16
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty