Provider Demographics
NPI:1699120816
Name:EVOLVE COUNSELING LLC
Entity type:Organization
Organization Name:EVOLVE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPANGLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:715-298-6201
Mailing Address - Street 1:2600 RIB MOUNTAIN DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-7196
Mailing Address - Country:US
Mailing Address - Phone:715-298-6201
Mailing Address - Fax:715-600-9031
Practice Address - Street 1:2600 RIB MOUNTAIN DR
Practice Address - Street 2:SUITE 101
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-7196
Practice Address - Country:US
Practice Address - Phone:715-298-6201
Practice Address - Fax:715-600-9031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5581125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100039690Medicaid