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General NPI Number Information
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NPI Number | 1073293155
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Entity Type | Organization
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Legal Business Name | EVOLVE AUTISM SERVICES, LLC
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Dates
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Enumeration Date | 07/24/2023
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Last Update Date | 07/24/2023
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Provider Practice Location Address
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Address Line | 111 WARWICK DR
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City | LONG BEACH
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State | MS
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Zip | 39560-2638
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Country | US
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Telephone | 228-260-6892
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Fax | 228-567-4894
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Provider Business Mailing Address
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Address Line | 111 WARWICK DR
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City | LONG BEACH
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State | MS
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Zip | 39560-2638
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Country | US
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Telephone |
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Fax | 228-567-4894
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Authorized Official
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Title or Position | BCBA
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Name | ASHLYN FLETCHER
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Credential | BCBA
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Telephone | 228-260-6892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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