Provider Demographics
NPI:1336410141
Name:SYNCHRONY OF VISALIA, INC.
Entity Type:Organization
Organization Name:SYNCHRONY OF VISALIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ-NANCE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, MOB
Authorized Official - Phone:559-635-4252
Mailing Address - Street 1:1041 N DEMAREE ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-4119
Mailing Address - Country:US
Mailing Address - Phone:559-635-4252
Mailing Address - Fax:559-635-4281
Practice Address - Street 1:1041 N DEMAREE ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4119
Practice Address - Country:US
Practice Address - Phone:559-635-4252
Practice Address - Fax:559-635-4281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20528103TA0400X, 103TA0700X, 103TB0200X, 103TC0700X, 103TF0000X, 103TF0200X, 103TH0100X
CAPSY 20525103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty