| Evolving Lives Llc | |
|
1990 Louisville Rd Ste 107 Bowling Green KY 42101-1202 | |
| (270) 495-1222 | |
| (859) 209-6504 |
| Full Name | Evolving Lives Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1990 Louisville Rd Ste 107, Bowling Green, Kentucky |
| Authorized Official Name and Position | Adria Whitlow (OWNER) |
| Authorized Official Contact | 2704951222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evolving Lives Llc 1990 Louisville Rd Ste 107 Bowling Green KY 42101-1202 Ph: (270) 495-1222 | Evolving Lives Llc 1990 Louisville Rd Ste 107 Bowling Green KY 42101-1202 Ph: (270) 495-1222 |
| NPI Number | 1477144046 |
|---|---|
| Provider Enumeration Date | 01/27/2021 |
| Last Update Date | 08/11/2023 |
| Certification Date | 08/11/2023 |
| Medicare PECOS PAC ID | 7810420437 |
|---|---|
| Medicare Enrollment ID | O20241104001684 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477144046 | NPI | - | NPPES |
| 7100720500 | Medicaid | KY | |
| 7100682470 | Medicaid | KY | |
| 7100811550 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Taylor Duncan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1083061394 PECOS PAC ID: 2365975158 Enrollment ID: I20241031004206 |
| Provider Name | Erica Hanner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1821520701 PECOS PAC ID: 5193258838 Enrollment ID: I20241101002010 |
| Provider Name | Adria Whitlow |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770716532 PECOS PAC ID: 0244763860 Enrollment ID: I20241205001337 |
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