EVOLVE FAMILY THERAPY PC (NPI# 1194230086) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194230086 |
| Entity Type | Organization |
| Organization Name | EVOLVE FAMILY THERAPY PC |
| Practice Address |
359 W 11th St Ste A1 Tracy CA 95376-3863 |
| Mailing Address |
3021 Balboa Dr Tracy CA 95376-1905 |
| Practice Telephone | 2096032929 |
| Mailing Telephone | 2096032929 |
| Enumeration Date | 2017-12-13 |
| Last Update Date | 2017-12-13 |
| Authorized Official Name | JONI LEA DICKSON GARCIA (CLINICIAN/COE) |
| Authorized Official Telephone | 2096032929 |
| Authorized Official Credential | LMFT #102382 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
102382 | CA | Ambulatory Health Care Facilities |
| Street Address |
359 W 11TH ST STE A1 |
| City | TRACY |
| State | CA |
| Zip Code | 95376-3863 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932757150 | James Burgess Angel | Technician, Other | 455 W. Eaton Ave., Tracy, CA 95376 | 2019-08-30 |
| 1477079655 | Cassandra Sierra | Specialist/Technologist | 632 W 11th St Ste 119, Tracy, CA 95376 | 2017-08-18 |
| 1922465491 | Jasmeer Kaur Uppal | Registered Nurse | 1411 N. Tracy Bl., Tracy, CA 95376 | 2016-01-28 |
| 1679957773 | Amy Forester | Physical Therapy Assistant | 1752 Schantz Way, Tracy, CA 95376 | 2015-07-17 |
| 1477966265 | Sarah Ojeda | Marriage & Family Therapist | 19 East 6th Street, Tracy, CA 95376 | 2014-06-09 |
| 1356761209 | Lucille Nowakowski | Registered Nurse | 95 West 11 Th St, Tracy, CA 95376 | 2014-04-18 |
| 1821417718 | Ricardo Echon | Nurse Practitioner | 644 W 12th Street, Tracy, CA 95376 | 2014-04-08 |
| 1508105354 | Sutter Central Valley Hospitals | Pharmacy | 1420 N. Tracy Blvd., Tracy, CA 95376 | 2013-02-13 |
| 1790034056 | Amy Powers | Counselor | 902 N Central Ave Ste 308, Tracy, CA 95376 | 2012-09-02 |
| 1982951554 | Gurpreet Singh Dhaliwal Md Inc. | Anesthesiology | 1530 Bessie Ave Ste 104, Tracy, CA 95376 | 2012-08-13 |
| Find all providers in zip 95376 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
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| 1962016527 | Los Angeles County Department of Mental Health | Clinic/Center | 2934 E Garvey Ave South Ste 230, West Covina, CA 91791-6101 | 2020-09-01 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.