Organization
DIVERGENT BEHAVIORAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY MOORE (OWNER)
(417) 684-2332
Entity
Organization
Contact information
Practice address
3696 W BLAKEY ST, SPRINGFIELD, MO 65810-1105
(417) 323-2435
Mailing address
3696 W BLAKEY ST, SPRINGFIELD, MO 65810-1105
(417) 323-2435
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
10/15/2024
Last updated
10/15/2024
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