Provider Demographics
NPI:1275186058
Name:SYNERGY COUNSELING LLC
Entity Type:Organization
Organization Name:SYNERGY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MISSY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDDLES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-265-8866
Mailing Address - Street 1:11219 W RENO AVE
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-7569
Mailing Address - Country:US
Mailing Address - Phone:405-265-8866
Mailing Address - Fax:405-384-1221
Practice Address - Street 1:11219 W RENO AVE STE 1
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-7569
Practice Address - Country:US
Practice Address - Phone:405-265-8866
Practice Address - Fax:405-384-1221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)