Provider Demographics
NPI:1972350999
Name:EVOLVE AURA WELLNESS
Entity type:Organization
Organization Name:EVOLVE AURA WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JULINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:321-209-1299
Mailing Address - Street 1:152 N HARBOR CITY BLVD #100
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-3661
Mailing Address - Country:US
Mailing Address - Phone:321-209-1299
Mailing Address - Fax:321-517-2900
Practice Address - Street 1:152 N HARBOR CITY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-6794
Practice Address - Country:US
Practice Address - Phone:321-209-1299
Practice Address - Fax:321-517-2900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty