Healthcare Provider Details

I. General information

NPI: 1841126661
Provider Name (Legal Business Name): DIVERGENT COLLECTIVE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3202 E LAS ROCAS DR
PHOENIX AZ
85028-4913
US

IV. Provider business mailing address

3202 E LAS ROCAS DR
PHOENIX AZ
85028-4913
US

V. Phone/Fax

Practice location:
  • Phone: 805-206-5625
  • Fax:
Mailing address:
  • Phone: 805-206-5625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: CHELSEA KNORR
Title or Position: CEO/OWNER
Credential:
Phone: 805-206-5625