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General NPI Number Information
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NPI Number | 1619686557
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Entity Type | Organization
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Legal Business Name | COUNSELING AND NEURO DYNAMICS, INC.
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Dates
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Enumeration Date | 11/18/2022
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Last Update Date | 11/18/2022
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Provider Practice Location Address
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Address Line | 4101 MCGOWEN ST STE 233
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City | LONG BEACH
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State | CA
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Zip | 90808-1898
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Country | US
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Telephone | 562-714-2146
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Fax | 708-824-0555
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Provider Business Mailing Address
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Address Line | 7725 DEAN MARTIN DR
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City | LAS VEGAS
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State | NV
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Zip | 89139-6612
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Country | US
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Telephone | 773-619-2001
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. DEVONE VERSE SR.
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Credential | PHD
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Telephone | 773-619-2001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health 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 | 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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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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