Provider Demographics
NPI:1053856336
Name:SYZYGY, LLC
Entity Type:Organization
Organization Name:SYZYGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LYON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:208-874-7969
Mailing Address - Street 1:676 W PULLMAN RD
Mailing Address - Street 2:#235
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-2061
Mailing Address - Country:US
Mailing Address - Phone:208-874-7969
Mailing Address - Fax:
Practice Address - Street 1:676 W PULLMAN RD
Practice Address - Street 2:#235
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-2061
Practice Address - Country:US
Practice Address - Phone:208-874-7969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty