OrganizationDivergent Path Therapy, PllcSocial WorkerBehavioral Health & Social Service ProvidersPractice Address1340 N Astor St Unit 2205, Chicago, IL 60610-8432(757) 903-1246PECOS EnrollmentBased on the most recent information from CMS, provider Divergent Path Therapy, Pllc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1417778101Provider TypeOrganizationFull NameDivergent Path Therapy, PllcSubpartNoEnumeration Date10/24/2024Last Updated10/24/2024Contact InformationPractice LocationPractice Address1340 N Astor St Unit 2205, Chicago, IL 60610-8432Phone(757) 903-1246FaxUnlisted FaxMailing LocationMailing Address1340 N Astor St Unit 2205, Chicago, IL 60610-8432PhoneUnlisted PhoneFaxUnlisted FaxAuthorized OfficialNameHoward, Julia (Psychotherapist)Phone(757) 903-1246Provider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer