| Evolve Therapeutic Center | |
|
304 W Mondamin St Suite 104 Minooka IL 60447-9096 | |
| (815) 685-7601 | |
| Not Available |
| Full Name | Evolve Therapeutic Center |
|---|---|
| Speciality | Counselor - Professional |
| Location | 304 W Mondamin St, Minooka, Illinois |
| Authorized Official Name and Position | Angela Decraene (OWNER) |
| Authorized Official Contact | 8156857601 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evolve Therapeutic Center Po Box 608 Minooka IL 60447-0608 Ph: (815) 685-7601 | Evolve Therapeutic Center 304 W Mondamin St Suite 104 Minooka IL 60447-9096 Ph: (815) 685-7601 |
| NPI Number | 1508315920 |
|---|---|
| Provider Enumeration Date | 09/27/2016 |
| Last Update Date | 09/27/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508315920 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 180.008724 (Illinois) | Primary |
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