Provider Demographics
NPI:1285391797
Name:THE EVOLUTION OF HER
Entity type:Organization
Organization Name:THE EVOLUTION OF HER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:D
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:L P C
Authorized Official - Phone:918-407-9803
Mailing Address - Street 1:4867 S SHERIDAN RD STE 712A
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-5721
Mailing Address - Country:US
Mailing Address - Phone:918-550-5958
Mailing Address - Fax:
Practice Address - Street 1:4867 S SHERIDAN RD STE 712A
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-5721
Practice Address - Country:US
Practice Address - Phone:918-550-5958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty