Evolve Therapy and Wellness

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

EVOLVE THERAPY AND WELLNESS

Practice address

12 1St Ave W
Williston, ND 58801-6048

Phone

(701) 609-5376

Fax

(866) 635-1623

NPI assigned

May 14, 2024

Organization subpart

No

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

Authorized official

Name

Staci Ekblad, LPCC-S RPTNPI 1992969323

Title

Owner

Phone

(701) 866-3380

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Staci Lynn Ekblad, LAPC

  • Mental Health Counselor
  • Williston, ND
  • NPI 1992969323
  NPD Authorized official
• Fallon Kirby Leiseth

  • Mental Health Counselor
  • Williston, ND
  • NPI 1104467174
  NPD

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

{
    "created_epoch": "1715644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715644800000",
    "number": "1801645866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 1ST AVE W",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588016048",
            "telephone_number": "701-609-5376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 1ST AVE W",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588016048",
            "telephone_number": "701-609-5376",
            "fax_number": "866-635-1623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOLVE THERAPY AND WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-14",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A",
        "authorized_official_last_name": "EKBLAD",
        "authorized_official_first_name": "STACI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "701-866-3380",
        "authorized_official_credential": "LPCC-S RPT"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hailey Enno
• Lisa Enno
• Amanda Kay Erickson, DPT
• Gracia Erickson
• Kathryn Evans
• Fairlight Medical Center
• Fairlight Medical Center
• Misty K Falcon, NP
• Family Recovery Home
• Fargo Vamc

• Mental Health Counselor in Williston, ND
• Providers in Williston, ND by specialty
• Mental Health Counselor in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2024; 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.