Provider Demographics
NPI:1841945870
Name:EVOLVE HEALING AND WELLNESS CENTER
Entity type:Organization
Organization Name:EVOLVE HEALING AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARI
Authorized Official - Middle Name:ALYSSE
Authorized Official - Last Name:WEITERSCHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-945-7566
Mailing Address - Street 1:579 N 1ST BANK DR STE 150
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-8102
Mailing Address - Country:US
Mailing Address - Phone:312-945-7566
Mailing Address - Fax:
Practice Address - Street 1:579 N 1ST BANK DR STE 150
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-8102
Practice Address - Country:US
Practice Address - Phone:312-945-7566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-17
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health