Healthcare Provider Details

I. General information

NPI: 1043929243
Provider Name (Legal Business Name): DIVERGENCE MENTAL HEALTH GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2022
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 PLAZA DR STE 340
HIGHLANDS RANCH CO
80129-2399
US

IV. Provider business mailing address

4420 LYNDENWOOD CIR
HIGHLANDS RANCH CO
80130-8807
US

V. Phone/Fax

Practice location:
  • Phone: 720-310-8786
  • Fax:
Mailing address:
  • Phone: 847-894-7288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY LYNN EDWARDSON
Title or Position: OWNER
Credential: LPC
Phone: 847-894-7288