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General NPI Number Information
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NPI Number | 1558173997
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Entity Type | Organization
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Legal Business Name | EVOLVE THERAPY LLC
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 7905 W 159TH ST STE C
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City | TINLEY PARK
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State | IL
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Zip | 60477-1345
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Country | US
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Telephone | 705-580-7601
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Fax | 708-580-7602
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Provider Business Mailing Address
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Address Line | 7905 W 159TH ST STE C
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City | TINLEY PARK
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State | IL
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Zip | 60477-1345
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Country | US
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Telephone | 705-580-7601
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Fax | 708-580-7602
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Authorized Official
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Title or Position | OWNER
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Name | LOI LOGAN
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Credential | LCSW
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Telephone | 708-580-7601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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