Provider Demographics
NPI:1225058001
Name:DIVERSE VENTURES, LLC
Entity Type:Organization
Organization Name:DIVERSE VENTURES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMECA
Authorized Official - Middle Name:
Authorized Official - Last Name:FALCONER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:314-495-2600
Mailing Address - Street 1:69 BELLERIVE ACRES
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-4330
Mailing Address - Country:US
Mailing Address - Phone:314-389-5007
Mailing Address - Fax:314-389-6023
Practice Address - Street 1:69 BELLERIVE ACRES
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-4330
Practice Address - Country:US
Practice Address - Phone:314-389-5007
Practice Address - Fax:314-389-6023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006006565103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty