Provider Demographics
NPI:1134707664
Name:EVOLVE PSYCHOLOGY LLC
Entity type:Organization
Organization Name:EVOLVE PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:LLP
Authorized Official - Phone:734-404-8623
Mailing Address - Street 1:8898 COMMERCE RD STE 3A
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-4485
Mailing Address - Country:US
Mailing Address - Phone:734-404-8623
Mailing Address - Fax:
Practice Address - Street 1:8898 COMMERCE RD STE 3A
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-4485
Practice Address - Country:US
Practice Address - Phone:734-404-8623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)