Evo Health and Wellness, LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

EVO HEALTH AND WELLNESS, LLC

Practice address

340 Sunset Ave
Venice, CA 90291-2632

Phone

(210) 246-4756

NPI assigned

Jun 20, 2018

Last updated

Jun 20, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Koorosh Rassekh, MFFT

Title

Managing Member

Phone

(310) 205-6991

Specialties & licenses 3

Addresses

Other names 1

• Sanyama Behavioral and Mental Health, LLC. Former legal business name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gali Barak, LMFT

  • Marriage & Family Therapist
  • Los Angeles, CA
  • NPI 1952894370
  NPD (past)

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

{
    "created_epoch": "1529452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529452800000",
    "number": "1306330568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 SUNSET AVE",
            "city": "VENICE",
            "state": "CA",
            "postal_code": "902912632",
            "telephone_number": "210-246-4756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 SUNSET AVE",
            "city": "VENICE",
            "state": "CA",
            "postal_code": "902912632",
            "telephone_number": "210-246-4756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVO HEALTH AND WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-20",
        "last_updated": "2018-06-20",
        "status": "A",
        "authorized_official_last_name": "RASSEKH",
        "authorized_official_first_name": "KOOROSH",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "310-205-6991",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MFFT"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sanyama Behavioral and Mental Health, LLC.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• El Dorado Community Service Center (Venice Medical & Mental Health Services)
• Mary Hunter Ellegood, L. AC.
• Emily Elson, MFT
• Mary Eno, M.D.
• Adriana Eversole
• Justin Fearrington
• Todd Feinman, M.D.
• Felt Psychotherapy Collective
• Michel Ferguson
• Melissa Fernandez

• Mental Health Counselor in Venice, CA
• Providers in Venice, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; 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.