Convergent Brain Diagnostics

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

Legal business name

CONVERGENT BRAIN DIAGNOSTICS

Practice address

4359 Town Center Blvd Ste 217
El Dorado Hills, CA 95762-7113

Phone

(916) 836-0036

Fax

(916) 345-7950

NPI assigned

Feb 3, 2022

Organization subpart

No

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

Authorized official

Name

Mrs. Maryjo Brooks-Motl, LMFT

Title

Vice President/Clinical Director

Phone

(916) 836-0036

Specialties & licenses 1

Addresses

Other names 1

• MotlMD Doing business as

Locations

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

{
    "created_epoch": "1643846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643846400000",
    "number": "1902550445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4359 TOWN CENTER BLVD STE 217",
            "city": "EL DORADO HILLS",
            "state": "CA",
            "postal_code": "957627113",
            "telephone_number": "916-836-0036",
            "fax_number": "916-345-7950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4359 TOWN CENTER BLVD STE 217",
            "city": "EL DORADO HILLS",
            "state": "CA",
            "postal_code": "957627113",
            "telephone_number": "916-836-0036",
            "fax_number": "916-345-7950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONVERGENT BRAIN DIAGNOSTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-03",
        "last_updated": "2022-02-03",
        "certification_date": "2022-02-03",
        "status": "A",
        "authorized_official_last_name": "BROOKS-MOTL",
        "authorized_official_first_name": "MARYJO",
        "authorized_official_title_or_position": "VICE PRESIDENT/CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "916-836-0036",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MotlMD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christopher Colletti
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• Nathan Conover
• Kelli Cooper
• Benjamin Cope, D.D.S.
• James Christopher Cope, D.D.S.
• Jazelle Copeland
• Raquel Cornejo

• Marriage & Family Therapist in El Dorado Hills, CA
• Providers in El Dorado Hills, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2022; 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.