| NPI | 1316708993 |
|---|---|
| Doing Business As | EVOLVE BEHAVIORAL HEALTH |
| Entity Type | Organization |
| Authorized Contact | JESSI BLACKSTOCK TIDWELL Co Owner 256-394-0880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2024-01-19 |
| Last Update Date | 2024-01-19 |