Provider Demographics
NPI:1558173997
Name:EVOLVE THERAPY LLC
Entity type:Organization
Organization Name:EVOLVE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOI
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:708-580-7601
Mailing Address - Street 1:7905 W 159TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1345
Mailing Address - Country:US
Mailing Address - Phone:705-580-7601
Mailing Address - Fax:708-580-7602
Practice Address - Street 1:7905 W 159TH ST STE C
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1345
Practice Address - Country:US
Practice Address - Phone:705-580-7601
Practice Address - Fax:708-580-7602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty