NPIMap

Organization Active NPI

Evolve LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Appleton, WI
National Provider Identifier
1821541137
Registry record updated Jun 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
EVOLVE LLC
Practice address
3416 Association Dr
Appleton, WI 54914
Phone
(920) 364-9078
Fax
(920) 243-1792
NPI assigned
Aug 3, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2023

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

Authorized official

Name
Elliott RichelsonNPI 1124018056
Title
Authorized Official
Phone
(904) 514-7070

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Adult Mental Health Clinic/Center 261QM0850X
Adolescent and Children Mental Health Clinic/Center 261QM0855X
Psychiatric Residential Treatment Facility 323P00000X

Addresses

Primary practice location

3416 Association Dr
Appleton, WI 54914

Mailing address

320 1St St Ste 712
Jax Beach, FL 32250

Other practice location 1

1504 S Commercial St
Neenah, WI 54956-4802
Phone (920) 570-6339

National Provider Directory

National Provider Directory

Locations

320 1st St N
Ste 712
Jax Bch, FL 32250
Phone (941) 444-1730

1710 Lawrence Dr
Ste 200
De Pere, WI 54115
Phone (920) 364-9078

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/24776/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1470182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687996800000",
    "number": "1821541137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 1ST ST STE 712",
            "city": "JAX BEACH",
            "state": "FL",
            "postal_code": "32250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3416 ASSOCIATION DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "54914",
            "telephone_number": "920-364-9078",
            "fax_number": "920-243-1792"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1504 S Commercial St",
            "address_purpose": "LOCATION",
            "city": "Neenah",
            "state": "WI",
            "postal_code": "549564802",
            "country_code": "US",
            "telephone_number": "920-570-6339",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EVOLVE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-03",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-29",
        "status": "A",
        "authorized_official_last_name": "RICHELSON",
        "authorized_official_first_name": "ELLIOTT",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "904-514-7070"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2023; 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.