Provider Demographics
NPI:1114671492
Name:SYNERGY BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:SYNERGY BEHAVIORAL HEALTH LLC
Other - Org Name:SYNERGY TELEMED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:NGOZI
Authorized Official - Last Name:NWOKO
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:312-593-4127
Mailing Address - Street 1:14130 S HILLTOP LN UNIT 204
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-4982
Mailing Address - Country:US
Mailing Address - Phone:312-593-4127
Mailing Address - Fax:
Practice Address - Street 1:1 WESTBROOK CORPORATE CTR STE 300
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-5709
Practice Address - Country:US
Practice Address - Phone:800-460-9633
Practice Address - Fax:630-358-6690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty