1629314844 NPI number — SYNERGY BEHAVIORAL HEALTH, P. C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629314844 NPI number — SYNERGY BEHAVIORAL HEALTH, P. C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SYNERGY BEHAVIORAL HEALTH, P. C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629314844
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 W MCKAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARLSBAD
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88220-5835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-725-5562
Provider Business Mailing Address Fax Number:
575-541-3495

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 W MCKAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARLSBAD
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88220-5835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-725-5562
Provider Business Practice Location Address Fax Number:
575-541-3495
Provider Enumeration Date:
12/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SPARKMAN
Authorized Official First Name:
LORETTA
Authorized Official Middle Name:
MARGARET
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
575-725-5562

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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