Provider Demographics
NPI:1033476676
Name:SYNERGY COUNSELING SERVICES
Entity Type:Organization
Organization Name:SYNERGY COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:314-382-9318
Mailing Address - Street 1:9167 W FLORISSANT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-1420
Mailing Address - Country:US
Mailing Address - Phone:314-382-9318
Mailing Address - Fax:314-260-1922
Practice Address - Street 1:9167 W FLORISSANT AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-1420
Practice Address - Country:US
Practice Address - Phone:314-382-9318
Practice Address - Fax:314-260-1922
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARVIN STEVEN MILLER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008008117251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1164736690Medicaid