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CONVERGENT BRAIN DIAGNOSTICS NPI 1902550445


NPI Information

NPI: 1902550445
Provider Name: CONVERGENT BRAIN DIAGNOSTICS
Classification: Marriage & Family Therapist - 106H00000X
Entity Type: Organization
Address:
4359 TOWN CENTER BLVD STE 217
EL DORADO HILLS, CA
ZIP 95762
Phone: (916) 836-0036
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CONVERGENT BRAIN DIAGNOSTICS is a marriage family therapist in El Dorado Hills, CA. The provider is a marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups. CONVERGENT BRAIN DIAGNOSTICS NPI is 1902550445. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

4359 TOWN CENTER BLVD STE 217
EL DORADO HILLS, CA
ZIP 95762-113
Phone: (916) 836-0036
Fax: (916) 345-7950

The provider's authorized official is Maryjo Brooks-motl .
The authorized official title is Vice President/clinical Director and has the following contact phone number (916) 836-0036.

The enumeration date for this NPI number is 2/3/2022 and was last updated on 2/3/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1106H00000XMarriage & Family TherapistYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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