Provider Demographics
NPI:1306461983
Name:EVOLUTION COUNSELING AND WELLNESS SERVICES
Entity type:Organization
Organization Name:EVOLUTION COUNSELING AND WELLNESS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/CLINICAL MENTAL HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, LCDC
Authorized Official - Phone:254-291-5058
Mailing Address - Street 1:9901 BRODIE LN STE 160-966
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-5803
Mailing Address - Country:US
Mailing Address - Phone:254-291-5058
Mailing Address - Fax:
Practice Address - Street 1:9901 BRODIE LN STE 160-966
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-5803
Practice Address - Country:US
Practice Address - Phone:512-995-9995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-10
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty