Provider Demographics
NPI:1295541860
Name:DIVERGENT PSYCHOLOGICAL ASSESSMENT, PLLC
Entity type:Organization
Organization Name:DIVERGENT PSYCHOLOGICAL ASSESSMENT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:515-451-1963
Mailing Address - Street 1:7331 SWITCHGRASS RD
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-3294
Mailing Address - Country:US
Mailing Address - Phone:515-451-1963
Mailing Address - Fax:
Practice Address - Street 1:6136 FRISCO SQUARE BLVD STE 400487A
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-3246
Practice Address - Country:US
Practice Address - Phone:515-451-1963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-09
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty