Provider Demographics
NPI:1063225258
Name:SELF EVOLUTION THERAPY LLC
Entity type:Organization
Organization Name:SELF EVOLUTION THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:YOLISMA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARIBAY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:713-449-3339
Mailing Address - Street 1:11838 CASTLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-2611
Mailing Address - Country:US
Mailing Address - Phone:713-449-3339
Mailing Address - Fax:
Practice Address - Street 1:11838 CASTLE RIDGE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-2611
Practice Address - Country:US
Practice Address - Phone:713-449-3339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty