Healthcare Provider Details

I. General information

NPI: 1619686557
Provider Name (Legal Business Name): COUNSELING AND NEURO DYNAMICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 MCGOWEN ST STE 233
LONG BEACH CA
90808-1898
US

IV. Provider business mailing address

2760 LAKE SAHARA DR STE 106
LAS VEGAS NV
89117-3438
US

V. Phone/Fax

Practice location:
  • Phone: 562-714-2146
  • Fax: 708-824-0555
Mailing address:
  • Phone: 562-714-2146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. DEVONE VERSE SR.
Title or Position: DIRECTOR
Credential: PHD
Phone: 773-619-2001