Provider Demographics
NPI:1598017691
Name:SYNTHESIS MIND/BODY LLC
Entity Type:Organization
Organization Name:SYNTHESIS MIND/BODY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUGHES-KUDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-471-8077
Mailing Address - Street 1:121 NE A ST
Mailing Address - Street 2:STE A
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-2111
Mailing Address - Country:US
Mailing Address - Phone:541-471-8077
Mailing Address - Fax:541-471-8074
Practice Address - Street 1:121 NE A ST
Practice Address - Street 2:STE A
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-2111
Practice Address - Country:US
Practice Address - Phone:541-471-8077
Practice Address - Fax:541-471-8074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR263142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty