Provider Demographics
NPI:1578716775
Name:EVOLUTION: CHANGING PATHS THROUGH TALK THERAPY LLC
Entity Type:Organization
Organization Name:EVOLUTION: CHANGING PATHS THROUGH TALK THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LINDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:405-826-6052
Mailing Address - Street 1:121 W MAIN ST
Mailing Address - Street 2:SUIT 103
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-5136
Mailing Address - Country:US
Mailing Address - Phone:405-826-6052
Mailing Address - Fax:
Practice Address - Street 1:121 W MAIN ST
Practice Address - Street 2:SUIT 103
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5136
Practice Address - Country:US
Practice Address - Phone:405-826-6052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health