Provider Demographics
NPI:1316690852
Name:EVOKE CHANGES LLC
Entity type:Organization
Organization Name:EVOKE CHANGES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:BASS
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:406-823-0231
Mailing Address - Street 1:PO BOX 1371
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903-1371
Mailing Address - Country:US
Mailing Address - Phone:406-823-0231
Mailing Address - Fax:
Practice Address - Street 1:753 MIGRATION RD
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:MT
Practice Address - Zip Code:59932-5993
Practice Address - Country:US
Practice Address - Phone:406-823-0231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT523464Medicaid