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Organization
MENTALLY EVOLVED LLC
Active
Organization
MENTALLY EVOLVED LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TYIES ALEXANDER GOINES MSN, CRNP-PMH (CRNP-PMH)
(443) 939-4422
Entity
Organization
Contact information
Practice address
100 WEST RD STE 300, TOWSON, MD 21204-2370
(410) 832-7000
Mailing address
100 WEST RD STE 300, PMB 17673455, TOWSON, MD 21204-2370
(443) 939-4422
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
Other
Enumeration date
09/30/2026
Last updated
09/30/2026
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