Organization
EVOLVE365 THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOLLY GROSSE (ORGANIZER)
(262) 989-3737
Entity
Organization
Contact information
Practice address
715 KINGSTON AVE, RACINE, WI 53402-4046
(262) 989-3737
Mailing address
715 KINGSTON AVE, RACINE, WI 53402-4046
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
05/20/2022
Last updated
05/20/2022
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