Provider Demographics
NPI:1447962329
Name:EVOLUTION MENTAL HEALTH COUNSELING PLLC
Entity type:Organization
Organization Name:EVOLUTION MENTAL HEALTH COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELI
Authorized Official - Middle Name:ISKANDAR
Authorized Official - Last Name:KASSIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:607-217-4170
Mailing Address - Street 1:15 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2742
Mailing Address - Country:US
Mailing Address - Phone:607-217-4170
Mailing Address - Fax:
Practice Address - Street 1:15 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2742
Practice Address - Country:US
Practice Address - Phone:607-217-4170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-22
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty