| Divergent Shades | |
|
625 Fair Oaks Ave Ste 358 South Pasadena CA 91030-5812 | |
| (626) 460-6012 | |
| Not Available |
| Full Name | Divergent Shades |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 625 Fair Oaks Ave Ste 358, South Pasadena, California |
| Authorized Official Name and Position | Tara Ford Leufroy (PARTNER/OWNER/CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 8183699060 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Divergent Shades 625 Fair Oaks Ave Ste 358 South Pasadena CA 91030-5812 Ph: (626) 460-6012 | Divergent Shades 625 Fair Oaks Ave Ste 358 South Pasadena CA 91030-5812 Ph: (626) 460-6012 |
| NPI Number | 1942005830 |
|---|---|
| Provider Enumeration Date | 02/15/2025 |
| Last Update Date | 02/15/2025 |
| Certification Date | 02/15/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942005830 | NPI | - | NPPES |
| 1891120085 | Other | TARA LEUFROY NPI | |
| 1467877134 | Other | STEPHANIE REITER MORRISSEY'S NPI |
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