Provider Demographics
NPI:1316373236
Name:EVOLVE COUNSELING PLLC
Entity Type:Organization
Organization Name:EVOLVE COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBBIE
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:TATOM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:405-474-8020
Mailing Address - Street 1:3012 SE 96TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73160-9231
Mailing Address - Country:US
Mailing Address - Phone:405-474-8020
Mailing Address - Fax:
Practice Address - Street 1:725 NW 17TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2117
Practice Address - Country:US
Practice Address - Phone:405-474-8020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK43871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty