Provider Demographics
NPI:1033127444
Name:SYNERGY COUNSELING SERVICES, INC
Entity Type:Organization
Organization Name:SYNERGY COUNSELING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:C
Authorized Official - Last Name:VANROSSUM
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:715-526-5466
Mailing Address - Street 1:1415 EAST GREEN BAY ST.
Mailing Address - Street 2:SUITE 191
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-3881
Mailing Address - Country:US
Mailing Address - Phone:715-526-5466
Mailing Address - Fax:715-526-5545
Practice Address - Street 1:1415 EAST GREEN BAY ST.
Practice Address - Street 2:SUITE 191
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-3881
Practice Address - Country:US
Practice Address - Phone:715-526-5466
Practice Address - Fax:715-526-5545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1895101Y00000X
WI1896101Y00000X
WI1894101Y00000X
WI1802057103T00000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42225900Medicaid
WI42196300Medicaid
WI42196400Medicaid
WI42175300Medicaid
WI84082Medicare UPIN
WI42225900Medicaid