Provider Demographics
NPI:1962642884
Name:SYNERGISTIC HEALING
Entity Type:Organization
Organization Name:SYNERGISTIC HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HINCHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LICSW
Authorized Official - Phone:320-363-4223
Mailing Address - Street 1:1511 E MINNESOTA ST
Mailing Address - Street 2:PO BOX 33
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MN
Mailing Address - Zip Code:56374-8618
Mailing Address - Country:US
Mailing Address - Phone:320-363-4223
Mailing Address - Fax:
Practice Address - Street 1:1511 E MINNESOTA ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MN
Practice Address - Zip Code:56374-8618
Practice Address - Country:US
Practice Address - Phone:320-363-4223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN800001454Medicaid