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General NPI Number Information
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NPI Number | 1528186673
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Entity Type | Organization
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Legal Business Name | DIVERSIFIED CONSULTING, INC.
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 03/02/2011
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Provider Practice Location Address
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Address Line | 220D N SUNSET BLVD
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City | SHERMAN
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State | TX
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Zip | 75092-7465
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Country | US
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Telephone | 903-868-2961
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Fax | 903-892-2265
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Provider Business Mailing Address
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Address Line | 220 SUNSET BLVD D
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City | SHERMAN
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State | TX
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Zip | 75092-7466
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Country | US
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Telephone | 972-742-4582
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Fax | 903-892-2265
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Authorized Official
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Title or Position | CEO
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Name | MR. STACEY L GIBSON
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Credential |
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Telephone | 972-742-4582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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