Evolve Therapeutic Center
Organization Active NPI Professional Counselor · Minooka, IL
NPI 1508315920 · NPPES record last updated Sep 27, 2016
Key facts
- NPI
- 1508315920
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 180.008724 (IL)
- Legal business name
- EVOLVE THERAPEUTIC CENTER
- Practice address
- 304 W Mondamin St
Suite 104
Minooka, IL 60447-9096 - Phone
- (815) 685-7601
- NPI assigned
- Sep 27, 2016
- Organization subpart
- No
Authorized official
- Name
- Angela Decraene
- Title
- Owner
- Phone
- (815) 685-7601
National Provider Directory
Locations
304 W Mondamin St
Ste 104
Minooka, IL 60447
Phone (815) 272-7310
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor |
101YP2500X | 180.008724 | IL | Yes |
Addresses
Primary practice location
304 W Mondamin St
Suite 104
Minooka, IL 60447-9096
Mailing address
PO Box 608
Minooka, IL 60447-0608
Phone (815) 685-7601
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- Lorisa Marie Eby
- Maria Estilo
- Robert James Flynn
- Deborah E Franchi
- Jason Freeman
- Jason E Gall
- Cynthia Rene Garza
All providers in Minooka, IL · Professional Counselor in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 27, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.