Provider Demographics
NPI:1396398640
Name:EVOLIBRI CONSULTING
Entity Type:Organization
Organization Name:EVOLIBRI CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:JOHNSTON
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-245-1855
Mailing Address - Street 1:4655 OLD IRONSIDES DR STE 170
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-1853
Mailing Address - Country:US
Mailing Address - Phone:408-735-7990
Mailing Address - Fax:
Practice Address - Street 1:4655 OLD IRONSIDES DR STE 170
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-1853
Practice Address - Country:US
Practice Address - Phone:408-735-7990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty