| Evolve365 Therapy Llc | |
|
715 Kingston Ave Racine WI 53402-4046 | |
| (262) 989-3737 | |
| Not Available |
| Full Name | Evolve365 Therapy Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 715 Kingston Ave, Racine, Wisconsin |
| Authorized Official Name and Position | Molly Grosse (ORGANIZER) |
| Authorized Official Contact | 2629893737 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evolve365 Therapy Llc 715 Kingston Ave Racine WI 53402-4046 Ph: () - | Evolve365 Therapy Llc 715 Kingston Ave Racine WI 53402-4046 Ph: (262) 989-3737 |
| NPI Number | 1609514694 |
|---|---|
| Provider Enumeration Date | 05/20/2022 |
| Last Update Date | 05/20/2022 |
| Certification Date | 05/20/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609514694 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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