Organization
EVOLVE YOURSELF LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TISHLINN S FOUNTAIN LPC (CEO)
(504) 312-9388
Entity
Organization
Contact information
Practice address
1980 POST OAK BLVD STE 200, HOUSTON, TX 77056-3877
(877) 997-2620
(504) 910-1020
Mailing address
PO BOX 2717, GRETNA, LA 70054-2717
(877) 997-2620
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
104100000X
Social Worker
—
—
171M00000X
Case Manager/Care Coordinator
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
04/07/2022
Last updated
12/19/2022
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