# EVOLVE THERAPY AND WELLNESS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801645866
- **Authorized official:** STACI EKBLAD LPCC-S RPT (OWNER)
- **Authorized official phone:** (701) 866-3380

## Contact information

- **Practice address:** 12 1ST AVE W, WILLISTON, ND 58801-6048
- **Practice address phone:** (701) 609-5376
- **Practice address fax:** (866) 635-1623
- **Mailing address:** 12 1ST AVE W, WILLISTON, ND 58801-6048
- **Mailing address phone:** (701) 609-5376

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |

## Other

- **Enumeration date:** 05/14/2024
- **Last updated:** 05/14/2024