MEDICARE: SYNERGY ELEVATION GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1780409995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYNERGY ELEVATION GROUP LLC

Provider Business Mailing Address
First Line	:	10502 E COUNTY ROAD 104
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79706-5374
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12605 EAST FWY STE 308
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77015-5646
Country	:	US
Telephone Number	:	575-430-3990
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WILLIAM HARVEY
Credential	:
Telephone Number	:	575-430-3990

Provider Enumeration Date	:	11/21/2024
Last Update Date	:	11/21/2024

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