Provider Demographics
NPI:1801645866
Name:EVOLVE THERAPY AND WELLNESS
Entity type:Organization
Organization Name:EVOLVE THERAPY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACI
Authorized Official - Middle Name:
Authorized Official - Last Name:EKBLAD
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S RPT
Authorized Official - Phone:701-866-3380
Mailing Address - Street 1:12 1ST AVE W
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-6048
Mailing Address - Country:US
Mailing Address - Phone:701-609-5376
Mailing Address - Fax:
Practice Address - Street 1:12 1ST AVE W
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-6048
Practice Address - Country:US
Practice Address - Phone:701-609-5376
Practice Address - Fax:866-635-1623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty