Provider Demographics
NPI:1811735129
Name:DIVERGENT MINDS COUNSELING CENTER
Entity type:Organization
Organization Name:DIVERGENT MINDS COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOL MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOHLERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-812-4300
Mailing Address - Street 1:4730 BLACKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-7624
Mailing Address - Country:US
Mailing Address - Phone:406-475-5408
Mailing Address - Fax:
Practice Address - Street 1:702 N 19TH AVE STE 2C
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6069
Practice Address - Country:US
Practice Address - Phone:406-812-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty