Provider Demographics
NPI:1174380620
Name:EVO COUNSELING LLC
Entity type:Organization
Organization Name:EVO COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PODOLAK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:608-501-3361
Mailing Address - Street 1:715 HILL ST STE 270
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-3572
Mailing Address - Country:US
Mailing Address - Phone:608-501-3361
Mailing Address - Fax:
Practice Address - Street 1:715 HILL ST STE 270
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3572
Practice Address - Country:US
Practice Address - Phone:608-501-3361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIE063264Medicaid