Provider Demographics
NPI:1114636404
Name:SYNCHRONY THERAPEUTIC SERVICES, PLLC
Entity Type:Organization
Organization Name:SYNCHRONY THERAPEUTIC SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAULT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-529-1104
Mailing Address - Street 1:PO BOX 446
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903-0446
Mailing Address - Country:US
Mailing Address - Phone:406-529-1104
Mailing Address - Fax:
Practice Address - Street 1:307 1ST AVE E STE 16
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4965
Practice Address - Country:US
Practice Address - Phone:406-529-1104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty