Provider Demographics
NPI:1912718321
Name:EVOLVE MENTAL HEALTH, PLC
Entity type:Organization
Organization Name:EVOLVE MENTAL HEALTH, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:MELBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:701-751-0699
Mailing Address - Street 1:1830 E CENTURY AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0639
Mailing Address - Country:US
Mailing Address - Phone:701-751-0699
Mailing Address - Fax:701-401-0299
Practice Address - Street 1:1830 E CENTURY AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0639
Practice Address - Country:US
Practice Address - Phone:701-751-0699
Practice Address - Fax:701-401-0299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty