Provider Demographics
NPI:1194263103
Name:IEVOLVE TRANSFORMATIONAL SERVICES
Entity type:Organization
Organization Name:IEVOLVE TRANSFORMATIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / LEAD CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:KONGIT
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:800-967-9416
Mailing Address - Street 1:520 S GRAND AVE
Mailing Address - Street 2:SUITE 680
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90071-2600
Mailing Address - Country:US
Mailing Address - Phone:800-967-9416
Mailing Address - Fax:800-967-9416
Practice Address - Street 1:520 S GRAND AVE
Practice Address - Street 2:SUITE 680
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90071-2600
Practice Address - Country:US
Practice Address - Phone:800-967-9416
Practice Address - Fax:800-967-9416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97773106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty