Provider Demographics
NPI:1619686557
Name:COUNSELING AND NEURO DYNAMICS, INC.
Entity Type:Organization
Organization Name:COUNSELING AND NEURO DYNAMICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVONE
Authorized Official - Middle Name:
Authorized Official - Last Name:VERSE
Authorized Official - Suffix:SR
Authorized Official - Credentials:PHD
Authorized Official - Phone:773-619-2001
Mailing Address - Street 1:7725 DEAN MARTIN DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-6612
Mailing Address - Country:US
Mailing Address - Phone:773-619-2001
Mailing Address - Fax:
Practice Address - Street 1:4101 MCGOWEN ST STE 233
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1898
Practice Address - Country:US
Practice Address - Phone:562-714-2146
Practice Address - Fax:708-824-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty