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General NPI Number Information
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NPI Number | 1417668138
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Entity Type | Organization
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Legal Business Name | EVOLUTION MENTAL HEALTH
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Dates
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Enumeration Date | 12/13/2022
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Last Update Date | 02/13/2023
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Provider Practice Location Address
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Address Line | 1 HERITAGE DR STE 220
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City | SOUTHGATE
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State | MI
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Zip | 48195-3048
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Country | US
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Telephone | 734-672-0068
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Fax | 734-250-7864
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Provider Business Mailing Address
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Address Line | 1 HERITAGE DR STE 220
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City | SOUTHGATE
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State | MI
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Zip | 48195-3048
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Country | US
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Telephone | 734-672-0068
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Fax | 734-250-7864
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Authorized Official
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Title or Position | DIRECTOR
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Name | KIMBERLY MCFARLAND
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Credential | LPC
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Telephone | 734-672-0068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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