Provider Demographics
NPI:1942776018
Name:SYNERGY COUNSELING LLC
Entity Type:Organization
Organization Name:SYNERGY COUNSELING LLC
Other - Org Name:SYNERGY COUNSELING LLC TEDDI L GREENE SOLE MBR.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:TEDDI
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:509-994-6232
Mailing Address - Street 1:1124 W RIVERSIDE AVE # LL2
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-1132
Mailing Address - Country:US
Mailing Address - Phone:509-994-6232
Mailing Address - Fax:509-323-1607
Practice Address - Street 1:1124 W RIVERSIDE AVE # LL2
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-1132
Practice Address - Country:US
Practice Address - Phone:509-994-6232
Practice Address - Fax:509-323-1607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-16
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2103521Medicaid
WALW60291569OtherSTATE DEPARTMENT OF HEALTH LICENSE