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General NPI Number Information
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NPI Number | 1568176311
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Entity Type | Organization
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Legal Business Name | EVOLVE THERAPY SOLUTIONS, PLLC
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Dates
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Enumeration Date | 01/06/2023
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 235 S 3RD ST
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City | BATESVILLE
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State | AR
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Zip | 72501-5617
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Country | US
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Telephone | 870-799-4325
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Fax |
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Provider Business Mailing Address
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Address Line | 235 S 3RD ST
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City | BATESVILLE
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State | AR
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Zip | 72501-5617
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Country | US
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Telephone | 870-799-4325
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Fax |
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Authorized Official
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Title or Position | LCSW/OWNER
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Name | MARY BANKS
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Credential | LCSW
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Telephone | 870-799-4325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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