Provider Demographics
NPI:1922706290
Name:EVOLUTION HYPNOTHERAPY SERVICES LLC
Entity Type:Organization
Organization Name:EVOLUTION HYPNOTHERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLIENT LIAISON
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:VASEAU
Authorized Official - Last Name:SLEIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:313-829-8411
Mailing Address - Street 1:1537 MONROE ST STE 400
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2842
Mailing Address - Country:US
Mailing Address - Phone:313-898-1777
Mailing Address - Fax:
Practice Address - Street 1:1537 MONROE ST STE 400
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2842
Practice Address - Country:US
Practice Address - Phone:313-898-1777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty