Provider Demographics
NPI:1447269840
Name:EVOLVING MIND PSYCHOTHERAPY, INC.
Entity type:Organization
Organization Name:EVOLVING MIND PSYCHOTHERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARRIOS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:512-785-1195
Mailing Address - Street 1:PO BOX 90241
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78709-0241
Mailing Address - Country:US
Mailing Address - Phone:512-785-1195
Mailing Address - Fax:512-301-1175
Practice Address - Street 1:4201 BEE CAVE RD
Practice Address - Street 2:BLG. C, SUITE 213
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6465
Practice Address - Country:US
Practice Address - Phone:512-785-1195
Practice Address - Fax:512-301-1175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX299331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty