Provider Demographics
NPI:1073293155
Name:EVOLVE AUTISM SERVICES, LLC
Entity Type:Organization
Organization Name:EVOLVE AUTISM SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:
Authorized Official - First Name:ASHLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:228-260-6892
Mailing Address - Street 1:111 WARWICK DR
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560-2638
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:228-567-4894
Practice Address - Street 1:111 WARWICK DR
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560-2638
Practice Address - Country:US
Practice Address - Phone:228-260-6892
Practice Address - Fax:228-567-4894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty