Healthcare Provider Details

I. General information

NPI: 1568323418
Provider Name (Legal Business Name): SYNERGY BEHAVIORAL MENTAL HEALTH AND WELLNESS CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 N ST
SACRAMENTO CA
95816-5712
US

IV. Provider business mailing address

2344 ST PAULS WAY
MODESTO CA
95355-3390
US

V. Phone/Fax

Practice location:
  • Phone: 209-215-5124
  • Fax:
Mailing address:
  • Phone: 832-904-2349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: DAVIDSON ETOAMAIHE
Title or Position: PMHNP
Credential: NP
Phone: 832-904-2349