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General NPI Number Information
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NPI Number | 1295541860
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Entity Type | Organization
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Legal Business Name | DIVERGENT PSYCHOLOGICAL ASSESSMENT, PLLC
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 6136 FRISCO SQUARE BLVD STE 400487A
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City | FRISCO
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State | TX
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Zip | 75034-3246
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Country | US
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Telephone | 515-451-1963
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Fax |
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Provider Business Mailing Address
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Address Line | 7331 SWITCHGRASS RD
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City | FRISCO
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State | TX
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Zip | 75033-3294
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Country | US
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Telephone | 515-451-1963
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. YOLANDA CROSBY
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Credential | PH.D.
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Telephone | 515-451-1963
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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