NPIMap

Organization Active NPI

Divergent Dietitian

  • Adolescent and Children Mental Health Clinic/Center
  • Perrysburg, OH
National Provider Identifier
1083463749
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
DIVERGENT DIETITIAN
Practice address
308 Louisiana Ave
Perrysburg, OH 43551-1461
Phone
(567) 801-0792
NPI assigned
May 15, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Bethany Anne Dario, MPH, RDN, LDNPI 1104311513
Title
Owner
Phone
(419) 410-3541

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X Primary

Addresses

Primary practice location

308 Louisiana Ave
Perrysburg, OH 43551-1461

Mailing address

308 Louisiana Ave
Perrysburg, OH 43551-1461
Phone (419) 410-3541

National Provider Directory

National Provider Directory

Locations

308 Louisiana Ave
Perrysburg, OH 43551
Phone (419) 205-8320

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1715731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1083463749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 LOUISIANA AVE",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435511461",
            "telephone_number": "419-410-3541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 LOUISIANA AVE",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435511461",
            "telephone_number": "567-801-0792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERGENT DIETITIAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-15",
        "last_updated": "2025-09-11",
        "certification_date": "2024-05-15",
        "status": "A",
        "authorized_official_last_name": "DARIO",
        "authorized_official_first_name": "BETHANY",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "419-410-3541",
        "authorized_official_credential": "MPH, RDN, LD"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Perrysburg, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.