Provider Demographics
NPI:1881385474
Name:EVOLVE WITH INTEGRITY- CONSULTATION & BEHAVIORAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:EVOLVE WITH INTEGRITY- CONSULTATION & BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAREE
Authorized Official - Middle Name:
Authorized Official - Last Name:LINO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:863-934-1152
Mailing Address - Street 1:PO BOX 8574
Mailing Address - Street 2:
Mailing Address - City:LAKESHORE
Mailing Address - State:FL
Mailing Address - Zip Code:33854-8574
Mailing Address - Country:US
Mailing Address - Phone:863-934-1152
Mailing Address - Fax:
Practice Address - Street 1:3433 CLUB CIR
Practice Address - Street 2:
Practice Address - City:LAKESHORE
Practice Address - State:FL
Practice Address - Zip Code:33854-1230
Practice Address - Country:US
Practice Address - Phone:863-934-1152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10605100Medicaid