Provider Demographics
NPI:1457470825
Name:SYNCHRONY OF VISALIA, INC
Entity Type:Organization
Organization Name:SYNCHRONY OF VISALIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWYN
Authorized Official - Middle Name:W
Authorized Official - Last Name:ORTIZ-NANCE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:559-635-4252
Mailing Address - Street 1:1041 N. DEMAREE ST.
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-4119
Mailing Address - Country:US
Mailing Address - Phone:559-635-4252
Mailing Address - Fax:559-635-4281
Practice Address - Street 1:1041 N. DEMAREE ST.
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4119
Practice Address - Country:US
Practice Address - Phone:559-635-4252
Practice Address - Fax:559-635-4281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC24170101YM0800X
CAPSY18170103G00000X
CAPSY13698103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty