Provider Demographics
NPI:1902526510
Name:EVOLVE THERAPEUTIC SERVICES LLC
Entity Type:Organization
Organization Name:EVOLVE THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ALYCSON
Authorized Official - Last Name:ALDEA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:501-416-7777
Mailing Address - Street 1:415 N MCKINLEY ST STE 865
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3013
Mailing Address - Country:US
Mailing Address - Phone:501-416-7777
Mailing Address - Fax:
Practice Address - Street 1:415 N MCKINLEY ST STE 865
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3013
Practice Address - Country:US
Practice Address - Phone:501-416-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-01
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty