Provider Demographics
NPI:1922297803
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:PRESIDENT/CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:MBS, LPC, CART
Authorized Official - Phone:903-868-2961
Mailing Address - Street 1:142 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-5008
Mailing Address - Country:US
Mailing Address - Phone:580-920-2069
Mailing Address - Fax:580-920-1010
Practice Address - Street 1:142 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-5008
Practice Address - Country:US
Practice Address - Phone:580-920-2069
Practice Address - Fax:580-920-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health