Evolve Psychotherapy Services LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

6801093987 Issued in MI

Legal business name

EVOLVE PSYCHOTHERAPY SERVICES LLC

Practice address

2030 Packard St Ste B
Ann Arbor, MI 48104-4785

Phone

(708) 663-6279

NPI assigned

Jul 10, 2017

Last updated

Jun 29, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Julie Laforest

Title

Agent

Phone

(313) 633-4358

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1499644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687996800000",
    "number": "1205358512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2030 PACKARD ST STE B",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481044785",
            "telephone_number": "708-663-6279",
            "fax_number": "734-648-0581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2030 PACKARD ST STE B",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481044785",
            "telephone_number": "708-663-6279"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2122 Packard St",
            "address_purpose": "LOCATION",
            "city": "Ann Arbor",
            "state": "MI",
            "postal_code": "481044738",
            "country_code": "US",
            "telephone_number": "708-663-6279",
            "fax_number": "734-648-0581",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EVOLVE PSYCHOTHERAPY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-10",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-29",
        "status": "A",
        "authorized_official_last_name": "LAFOREST",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "AGENT",
        "authorized_official_telephone_number": "313-633-4358"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "MI",
            "license": "6801093987",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Ann Arbor, MI
• Providers in Ann Arbor, MI by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.