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Organization
DIVERGENT SHADES
Active
Organization
DIVERGENT SHADES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA FORD LEUFROY PSYD (PARTNER/OWNER/CLINICAL PSYCHOLOGIST)
(818) 369-9060
Entity
Organization
Contact information
Practice address
625 FAIR OAKS AVE STE 358, SOUTH PASADENA, CA 91030-5812
(626) 460-6012
Mailing address
625 FAIR OAKS AVE STE 358, SOUTH PASADENA, CA 91030-5812
(626) 460-6012
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC1900X
Counseling Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TS0200X
School Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1467877134
STEPHANIE REITER MORRISSEY'S NPI
—
01
—
1891120085
TARA LEUFROY NPI
—
Enumeration date
02/15/2025
Last updated
02/15/2025
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