Provider Demographics
NPI:1821785023
Name:EVOLVING FORWARD LLC
Entity Type:Organization
Organization Name:EVOLVING FORWARD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:OGLESBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-203-9415
Mailing Address - Street 1:9783 E 116TH ST
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-2822
Mailing Address - Country:US
Mailing Address - Phone:317-203-9415
Mailing Address - Fax:
Practice Address - Street 1:9783 E 116TH ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-2822
Practice Address - Country:US
Practice Address - Phone:317-203-9415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty