Provider Demographics
NPI:1841001187
Name:BENNETT EVOLUTION
Entity type:Organization
Organization Name:BENNETT EVOLUTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-356-0540
Mailing Address - Street 1:3 WEST MAIN ST
Mailing Address - Street 2:SUITE #202
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-2195
Mailing Address - Country:US
Mailing Address - Phone:614-356-0540
Mailing Address - Fax:
Practice Address - Street 1:3 WEST MAIN ST
Practice Address - Street 2:SUITE #202
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2195
Practice Address - Country:US
Practice Address - Phone:614-356-0540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOUGLAS BENNETT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty