# MENTALLY EVOLVED LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215841804
- **Authorized official:** MRS. TYIES ALEXANDER GOINES MSN, CRNP-PMH (CRNP-PMH)
- **Authorized official phone:** (443) 939-4422

## Contact information

- **Practice address:** 100 WEST RD STE 300, TOWSON, MD 21204-2370
- **Practice address phone:** (410) 832-7000
- **Mailing address:** 100 WEST RD STE 300, PMB 17673455, TOWSON, MD 21204-2370
- **Mailing address phone:** (443) 939-4422

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |

## Other

- **Enumeration date:** 09/30/2026
- **Last updated:** 09/30/2026