Provider Demographics
NPI:1699448357
Name:EVOLVEMENT BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:EVOLVEMENT BEHAVIORAL HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORDONEZ-BRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, LADAC
Authorized Official - Phone:575-635-7832
Mailing Address - Street 1:PO BOX 2314
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004-2314
Mailing Address - Country:US
Mailing Address - Phone:575-635-7832
Mailing Address - Fax:
Practice Address - Street 1:225 E IDAHO AVE STE 30
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3242
Practice Address - Country:US
Practice Address - Phone:575-635-7832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty