Provider Demographics
NPI:1629495296
Name:SYNERGY BEHAVIORAL HEALTH CENTER, P.C.
Entity Type:Organization
Organization Name:SYNERGY BEHAVIORAL HEALTH CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CLAY
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS LPCC LADAC
Authorized Official - Phone:505-879-0404
Mailing Address - Street 1:PO BOX 3579
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87305-3579
Mailing Address - Country:US
Mailing Address - Phone:505-726-9429
Mailing Address - Fax:
Practice Address - Street 1:211 W MESA AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-6382
Practice Address - Country:US
Practice Address - Phone:505-862-9992
Practice Address - Fax:505-862-9992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-21
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLPCC LADAC251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management