Organization
EVOLVING MIND SOLUTIONS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SARAH RYAN WELLBORN LCSW (PRESIDENT)
(817) 203-4779
Entity
Organization
Contact information
Practice address
4200 S HULEN ST STE 678, FORT WORTH, TX 76109-7902
(817) 203-4779
Mailing address
4200 S HULEN ST STE 678, FORT WORTH, TX 76109-7902
(817) 203-4779
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1225577471
TYPE 1 NPI
—
Enumeration date
10/22/2019
Last updated
10/09/2024
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