Healthcare Provider Details

I. General information

NPI: 1265393144
Provider Name (Legal Business Name): SYNERGY SOMATIC PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 N MARENGO AVE STE 405
PASADENA CA
91101-6114
US

IV. Provider business mailing address

16 N MARENGO AVE STE 405
PASADENA CA
91101-6114
US

V. Phone/Fax

Practice location:
  • Phone: 818-630-9961
  • Fax:
Mailing address:
  • Phone: 818-630-9961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ARIANNE MACBEAN
Title or Position: PRESIDENT
Credential: LMFT
Phone: 323-365-6627