| Evolutis, Llc | |
|
1504 Grand Central Ave Vienna WV 26105-1058 | |
| (877) 219-8726 | |
| (847) 960-5360 |
| Full Name | Evolutis, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1504 Grand Central Ave, Vienna, West Virginia |
| Authorized Official Name and Position | Sheel A Patel (CEO) |
| Authorized Official Contact | 3046158102 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evolutis, Llc Po Box 3120 Munster IN 46321-0120 Ph: (877) 219-8726 | Evolutis, Llc 1504 Grand Central Ave Vienna WV 26105-1058 Ph: (877) 219-8726 |
| NPI Number | 1821657941 |
|---|---|
| Provider Enumeration Date | 06/12/2019 |
| Last Update Date | 09/15/2022 |
| Certification Date | 09/15/2022 |
| Medicare PECOS PAC ID | 5597193607 |
|---|---|
| Medicare Enrollment ID | O20200323002590 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821657941 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TA0400X | Psychologist - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Tanisha N Hankerson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1174072698 PECOS PAC ID: 4486941671 Enrollment ID: I20161003002367 |
| Provider Name | Courtney Cornick |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1164973707 PECOS PAC ID: 2365870482 Enrollment ID: I20200323002858 |
| Provider Name | Jennifer Alpert |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1871810481 PECOS PAC ID: 0244639342 Enrollment ID: I20210521001462 |
| Provider Name | Nena Kircher |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1639406523 PECOS PAC ID: 0345405916 Enrollment ID: I20210831000723 |
| Provider Name | Alyssa Cunningham |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1831634161 PECOS PAC ID: 3173908498 Enrollment ID: I20220922000105 |
| Provider Name | Mona Bapat |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1427485655 PECOS PAC ID: 7214216142 Enrollment ID: I20230125003097 |
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