Active NPI
Evidential Therapy & Wellness LLC
- Psychiatric/Mental Health Nurse Practitioner
- Nottingham, MD
National Provider Identifier
1962295873
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- Legal business name
- EVIDENTIAL THERAPY & WELLNESS LLC
- Practice address
- 6 Mallow CT
Nottingham, MD 21236-1300 - Phone
- (443) 491-9469
- Fax
- (443) 222-9310
- NPI assigned
- May 23, 2025
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Iyobosa Joan Obasogie
- Title
- Ceo
- Phone
- (667) 303-2771
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | Primary |
Addresses
Primary practice location
6 Mallow CT
Nottingham, MD 21236-1300
Mailing address
6 Mallow CT
Nottingham, MD 21236-1300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
Enrollment records 1
National Provider Directory
National Provider Directory- Tax ID family
- Evidential Therapy Wellness LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Psychiatric/Mental Health Nurse Practitioner
- Nottingham, MD
- NPI 1669130233
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Psychiatric/Mental Health Nurse Practitioner
- Perry Hall, MD
- NPI 1154996395
Single Specialty
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1747958400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1747958400000",
"number": "1962295873",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6 MALLOW CT",
"city": "NOTTINGHAM",
"state": "MD",
"postal_code": "212361300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6 MALLOW CT",
"city": "NOTTINGHAM",
"state": "MD",
"postal_code": "212361300",
"telephone_number": "443-491-9469",
"fax_number": "443-222-9310"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EVIDENTIAL THERAPY & WELLNESS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2025-05-23",
"last_updated": "2025-05-23",
"certification_date": "2025-05-23",
"status": "A",
"authorized_official_last_name": "OBASOGIE",
"authorized_official_first_name": "IYOBOSA",
"authorized_official_middle_name": "JOAN",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "667-303-2771"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nottingham, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.