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General NPI Number Information
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NPI Number | 1124308846
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Entity Type | Organization
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Legal Business Name | EVOLUTION SERVICES, INC.
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Dates
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Enumeration Date | 08/25/2011
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Last Update Date | 12/17/2013
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Provider Practice Location Address
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Address Line | 520 S 3RD ST W
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City | MISSOULA
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State | MT
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Zip | 59801-2518
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Country | US
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Telephone | 406-240-3732
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Fax | 406-728-4009
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Provider Business Mailing Address
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Address Line | 520 S 3RD ST W
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City | MISSOULA
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State | MT
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Zip | 59801-2518
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Country | US
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Telephone | 406-240-3732
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Fax | 406-728-4009
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. JOCELYN M NELSON
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Credential | LCSW
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Telephone | 406-240-3732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SWP-LCSW-LIC-859
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License Number State | MT
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | SWP LCPC LIC 1393
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License Number State | MT
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