| Evolve Onward Llc | |
|
2310 N 68th St Wauwatosa WI 53213-1304 | |
| (414) 377-5481 | |
| (414) 377-5482 |
| Full Name | Evolve Onward Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 2310 N 68th St, Wauwatosa, Wisconsin |
| Authorized Official Name and Position | David William Doucette (OWNER/PSYCHOTHERAPIST) |
| Authorized Official Contact | 4143775481 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evolve Onward Llc 2310 N 68th St Wauwatosa WI 53213-1304 Ph: (414) 377-5481 | Evolve Onward Llc 2310 N 68th St Wauwatosa WI 53213-1304 Ph: (414) 377-5481 |
| NPI Number | 1144893363 |
|---|---|
| Provider Enumeration Date | 07/24/2021 |
| Last Update Date | 07/19/2022 |
| Certification Date | 07/19/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144893363 | NPI | - | NPPES |
| 100030427 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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