Organization
EVOLUTION AUTISM
Active
Organization
EVOLUTION AUTISM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GABRIELLE ROSEMAN (DIRECTOR)
(214) 984-4189
Entity
Organization
Contact information
Practice address
1801 S GREAT SOUTHWEST PKWY, GRAND PRAIRIE, TX 75051-3542
(214) 984-4189
Mailing address
822 WEAVER ST, CEDAR HILL, TX 75104-9235
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
251V00000X
Voluntary or Charitable Agency
—
—
252Y00000X
Early Intervention Provider Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261Q00000X
Clinic/Center
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
385HR2065X
Child Physical Disabilities Respite Care
—
—
Other
Enumeration date
12/05/2022
Last updated
12/05/2022
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