| Evolution Psychotherapy, Pllc | |
|
133 Blakely Rd Ste 202 Colchester VT 05446-3984 | |
| (802) 448-0448 | |
| Not Available |
| Full Name | Evolution Psychotherapy, Pllc |
|---|---|
| Speciality | Counselor |
| Location | 133 Blakely Rd Ste 202, Colchester, Vermont |
| Authorized Official Name and Position | Michael Sheppard (OWNER) |
| Authorized Official Contact | 8024480448 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evolution Psychotherapy, Pllc Po Box 541 Colchester VT 05446-0541 Ph: (802) 448-0448 | Evolution Psychotherapy, Pllc 133 Blakely Rd Ste 202 Colchester VT 05446-3984 Ph: (802) 448-0448 |
| NPI Number | 1720629462 |
|---|---|
| Provider Enumeration Date | 10/03/2019 |
| Last Update Date | 10/03/2019 |
| Medicare PECOS PAC ID | 0446695415 |
|---|---|
| Medicare Enrollment ID | O20240229001218 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720629462 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Michael James Sheppard |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1841640554 PECOS PAC ID: 1355786328 Enrollment ID: I20240229001401 |
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