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NPI Code Detail

MEDICARE: EVOLVING MINDS THERAPY, LLC

MEDICARE: EVOLVING MINDS THERAPY, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2261QM0850XAdult Mental Health Clinic/Center

General Provider Information

NPI Number : 1629717210
Entity Type Code : Organization
Provider Name (Legal Business Name) : EVOLVING MINDS THERAPY, LLC
Provider Business Mailing Address
First Line : 1130 UNIVERSITY BLVD STE B9
Second Line :
City : TUSCALOOSA
State : AL
Zip : 35401-0328
Country : US
Telephone Number : 205-235-2899
Fax Number :
Provider Business Practice Location Address
First Line : 212 W TROY ST STE B
Second Line :
City : DOTHAN
State : AL
Zip : 36303-4455
Country : US
Telephone Number : 205-235-2899
Fax Number :
Authorized Official
Title or Position : OWNER
Name : KIMBERLY ADAMS
Credential :
Telephone Number : 334-715-2055
Provider Enumeration Date : 06/01/2022
Last Update Date : 01/05/2026

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