Evolving Mind Solutions, LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

EVOLVING MIND SOLUTIONS, LLC

Practice address

4200 S Hulen St Ste 678
Fort Worth, TX 76109-7902

Phone

(817) 203-4779

NPI assigned

Oct 22, 2019

Last updated

Oct 9, 2024By 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

Mrs. Sarah Ryan Wellborn, LCSWNPI 1225577471

Title

President

Phone

(817) 203-4779

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sarah Ryan Wellborn, LCSW

  • Clinical Social Worker
  • Fort Worth, TX
  • NPI 1225577471
  NPD Authorized official

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

{
    "created_epoch": "1571702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728432000000",
    "number": "1326681354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 S HULEN ST STE 678",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761097902",
            "telephone_number": "817-203-4779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 S HULEN ST STE 678",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761097902",
            "telephone_number": "817-203-4779"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4200 S Hulen St Ste 682",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "761097905",
            "country_code": "US",
            "telephone_number": "817-203-4779",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EVOLVING MIND SOLUTIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-22",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A",
        "authorized_official_last_name": "WELLBORN",
        "authorized_official_first_name": "SARAH",
        "authorized_official_middle_name": "RYAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "817-203-4779",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 1 NPI",
            "identifier": "1225577471",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Evolve Wellness and Aesthetics PLLC
• Mackenzie John Ewart, DO
• Christopher Scott Ewin, M.D.
• Alison Harvey Ewing, APRN, FNP-C
• Beverly Jeanne Ewing, RN, MSN, FNP
• Julie Ewing

• Adult Mental Health Clinic/Center in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Adult Mental Health Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2024; 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.