| Name: | Evolve Behavioral Health, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 09 Jan 2024 (10 months ago) (Companies founded in January 2024) |
| Entity Number: | 001-115-299 |
| Register Number: | 001115299 |
| ZIP code: | 35630 (Companies in Lauderdale, 35630) |
| County: | Lauderdale |
| Place of Formation: | Alabama |
| Registered Office Street Address: | 2628 Hough RoadFlorence, AL 35630 |
| Registered Office Mailing Address: | 116 Pinebrook DriveFlorence, AL 35633 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316708993 | 2024-01-19 | 2024-01-19 | 215 MELISSA DR, MUSCLE SHOALS, AL, 356614752, US | 2628 HOUGH RD, FLORENCE, AL, 356301747, US | |||||||||||||||||
|
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| Phone | +1 256-394-0880 |
Authorized person
| Name | JESSI BLACKSTOCK TIDWELL |
| Role | CO- OWNER |
| Phone | 2563940880 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
| Name | Role |
|---|---|
| Tyson, Deborah A | Agent |
| Name | Role | Address |
|---|---|---|
| Tidwell, Jessi B | Organizer | 2628 Hough RoadFlorence, AL 35630 |
Date of last update: 18 Aug 2024
Sources: Alabama Secretary of State
