Organization
EVOLVED COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JACQUELINE SANDERS (CREDENTIALING ADMINISTRATOR)
(502) 630-2036
Entity
Organization
Contact information
Practice address
8814 TALON RIDGE DR, LOUISVILLE, KY 40229-6648
(502) 689-9952
(502) 632-1432
Mailing address
8814 TALON RIDGE DR, LOUISVILLE, KY 40229-6648
(502) 689-9952
(502) 632-1432
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100339200
—
KY
Enumeration date
06/19/2020
Last updated
06/19/2020
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