Provider Demographics
NPI:1548092745
Name:EVOLVE PSYCHIATRIC SERVICES, A PROFESSIONAL NURSING CORPORATION
Entity type:Organization
Organization Name:EVOLVE PSYCHIATRIC SERVICES, A PROFESSIONAL NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDERMOTT
Authorized Official - Suffix:
Authorized Official - Credentials:PMNHP-BC
Authorized Official - Phone:310-343-9424
Mailing Address - Street 1:4906 CALLE DE ARBOLES
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6260
Mailing Address - Country:US
Mailing Address - Phone:310-343-9424
Mailing Address - Fax:
Practice Address - Street 1:1611 S PACIFIC COAST HWY STE 307
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5614
Practice Address - Country:US
Practice Address - Phone:310-818-1902
Practice Address - Fax:844-888-0583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty