| Convergent Brain Diagnostics | |
|
4359 Town Center Blvd Ste 217 El Dorado Hills CA 95762-7113 | |
| (916) 836-0036 | |
| (916) 345-7950 |
| Full Name | Convergent Brain Diagnostics |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 4359 Town Center Blvd Ste 217, El Dorado Hills, California |
| Authorized Official Name and Position | Maryjo Brooks-motl (VICE PRESIDENT/CLINICAL DIRECTOR) |
| Authorized Official Contact | 9168360036 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Convergent Brain Diagnostics 4359 Town Center Blvd Ste 217 El Dorado Hills CA 95762-7113 Ph: (916) 836-0036 | Convergent Brain Diagnostics 4359 Town Center Blvd Ste 217 El Dorado Hills CA 95762-7113 Ph: (916) 836-0036 |
| NPI Number | 1902550445 |
|---|---|
| Provider Enumeration Date | 02/03/2022 |
| Last Update Date | 02/03/2022 |
| Certification Date | 02/03/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902550445 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
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