Organization
EVOLO PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHRYN E CANNELL LPC (OWNER/FOUNDER)
(208) 727-7360
Entity
Organization
Contact information
Practice address
416 S MAIN ST STE 102, HAILEY, ID 83333-8422
(208) 727-7360
Mailing address
361 CRANBROOK RD, HAILEY, ID 83333-8817
(208) 727-7360
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
Other
Enumeration date
02/15/2024
Last updated
02/15/2024
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