Evolve Counseling Center LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH11793 Issued in FL

Legal business name

EVOLVE COUNSELING CENTER LLC

Practice address

2999 NE 191St St
Suite 701
Aventura, FL 33180-3123

Phone

(786) 505-1145

Fax

(866) 838-1482

NPI assigned

May 13, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Tanya Johnson, LMHC

Title

Owner

Phone

(808) 343-0626

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1463097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463097600000",
    "number": "1104272624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2999 NE 191ST ST",
            "address_2": "SUITE 701",
            "city": "AVENTURA",
            "state": "FL",
            "postal_code": "331803123",
            "telephone_number": "786-505-1145",
            "fax_number": "866-838-1482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2999 NE 191ST ST",
            "address_2": "SUITE 701",
            "city": "AVENTURA",
            "state": "FL",
            "postal_code": "331803123",
            "telephone_number": "786-505-1145",
            "fax_number": "866-838-1482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOLVE COUNSELING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-13",
        "last_updated": "2016-05-13",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "TANYA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "808-343-0626",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH11793",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "015682200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Ettinger, LMSW
• Eugenio M Bricio MD PA
• Jasmin Evangelista, FNP - BC
• Karina Evangelista, M.S., LMHC
• Hanna Evans, APRN
• Expert Rehab, LLC
• Norma C Ezquerra
• Robert Keith Fabric, M.D.
• Henriete D Faillace, M.D.
• Giancarlo Antonio Falco, RNP

• Mental Health Counselor in Aventura, FL
• Providers in Aventura, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.