# CONVERGENT BRAIN DIAGNOSTICS

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** MotlMD
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902550445
- **Authorized official:** MRS. MARYJO BROOKS-MOTL LMFT (VICE PRESIDENT/CLINICAL DIRECTOR)
- **Authorized official phone:** (916) 836-0036

## Contact information

- **Practice address:** 4359 TOWN CENTER BLVD STE 217, EL DORADO HILLS, CA 95762-7113
- **Practice address phone:** (916) 836-0036
- **Practice address fax:** (916) 345-7950
- **Mailing address:** 4359 TOWN CENTER BLVD STE 217, EL DORADO HILLS, CA 95762-7113
- **Mailing address phone:** (916) 836-0036
- **Mailing address fax:** (916) 345-7950

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 02/03/2022
- **Last updated:** 02/03/2022