| Evolution Mental Health Services Pllc | |
|
6931 S 69th E Ave Ste 200 Tulsa OK 74133-1765 | |
| (918) 379-4431 | |
| (918) 328-2380 |
| Full Name | Evolution Mental Health Services Pllc |
|---|---|
| Speciality | Counselor |
| Location | 6931 S 69th E Ave Ste 200, Tulsa, Oklahoma |
| Authorized Official Name and Position | Gregory Michael Sutmiller (OWNER) |
| Authorized Official Contact | 9183794431 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evolution Mental Health Services Pllc 6931 S 66th East Ave Ste 200 Tulsa OK 74133-1765 Ph: (918) 379-4431 | Evolution Mental Health Services Pllc 6931 S 69th E Ave Ste 200 Tulsa OK 74133-1765 Ph: (918) 379-4431 |
| NPI Number | 1831714815 |
|---|---|
| Provider Enumeration Date | 06/15/2020 |
| Last Update Date | 04/02/2024 |
| Certification Date | 03/29/2024 |
| Medicare PECOS PAC ID | 5496106593 |
|---|---|
| Medicare Enrollment ID | O20240112000878 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831714815 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
| Provider Name | Gregory Michael Sutmiller |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1467690172 PECOS PAC ID: 6305297409 Enrollment ID: I20240112000981 |
| Provider Name | Mary Anthony Reese |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1730522996 PECOS PAC ID: 7113366865 Enrollment ID: I20240415002931 |
| Provider Name | Shelly Marie Kennedy Gonzalez |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1679923320 PECOS PAC ID: 5395184451 Enrollment ID: I20240422003081 |
| Provider Name | Alice Lucy Bonifield |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1356584817 PECOS PAC ID: 5597104653 Enrollment ID: I20240423000041 |
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