Provider Demographics
NPI:1245854371
Name:SYNERGIA INTEGRATED TELEBEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:SYNERGIA INTEGRATED TELEBEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-491-2796
Mailing Address - Street 1:2237 NE 169TH ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-6139
Mailing Address - Country:US
Mailing Address - Phone:206-365-3096
Mailing Address - Fax:
Practice Address - Street 1:2237 NE 169TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-6139
Practice Address - Country:US
Practice Address - Phone:206-365-3096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-04
Last Update Date:2022-08-19
Deactivation Date:2021-03-01
Deactivation Code:
Reactivation Date:2021-04-07
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty