Provider Demographics
NPI:1932804739
Name:EVOLUTIONARY COUNSELING, LLC
Entity Type:Organization
Organization Name:EVOLUTIONARY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:WILEY
Authorized Official - Last Name:LESLIE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:337-349-9662
Mailing Address - Street 1:20310 MONICA JOYCE LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-0144
Mailing Address - Country:US
Mailing Address - Phone:337-349-9662
Mailing Address - Fax:
Practice Address - Street 1:20310 MONICA JOYCE LN
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-0144
Practice Address - Country:US
Practice Address - Phone:337-349-9662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)