Provider Demographics
NPI:1417739418
Name:EVOLVE THERAPY AND WELLNESS LLC
Entity Type:Organization
Organization Name:EVOLVE THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:N
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:606-541-1067
Mailing Address - Street 1:162 DELUCA DR
Mailing Address - Street 2:
Mailing Address - City:SCIENCE HILL
Mailing Address - State:KY
Mailing Address - Zip Code:42553-9053
Mailing Address - Country:US
Mailing Address - Phone:606-541-1067
Mailing Address - Fax:
Practice Address - Street 1:162 DELUCA DR
Practice Address - Street 2:
Practice Address - City:SCIENCE HILL
Practice Address - State:KY
Practice Address - Zip Code:42553-9053
Practice Address - Country:US
Practice Address - Phone:606-541-1067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty