Provider Demographics
NPI:1528186673
Name:DIVERSIFIED CONSULTING, INC.
Entity Type:Organization
Organization Name:DIVERSIFIED CONSULTING, INC.
Other - Org Name:CENTER FOR PSYCHOLOGICAL DEVELOPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-742-4582
Mailing Address - Street 1:220 SUNSET BLVD
Mailing Address - Street 2:D
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7466
Mailing Address - Country:US
Mailing Address - Phone:972-742-4582
Mailing Address - Fax:903-892-2265
Practice Address - Street 1:220D N SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7465
Practice Address - Country:US
Practice Address - Phone:903-868-2961
Practice Address - Fax:903-892-2265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1528186673Medicaid
TX1528186673Medicaid