MEDICARE: SYNCHRONICITY MENTAL HEALTH SERVICES, 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	103TC0700X	Clinical Psychologist	962	AL

General Provider Information

NPI Number	:	1790007011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYNCHRONICITY MENTAL HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	468 PHILLIPS RD
Second Line	:
City	:	COTTONWOOD
State	:	AL
Zip	:	36320-4248
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	468 PHILLIPS RD
Second Line	:
City	:	COTTONWOOD
State	:	AL
Zip	:	36320-4248
Country	:	US
Telephone Number	:	334-648-6867
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	STARLA RAIBORN
Credential	:
Telephone Number	:	334-648-6867

Provider Enumeration Date	:	03/01/2010
Last Update Date	:	03/01/2010

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