Healthcare Provider Details

I. General information

NPI: 1497226153
Provider Name (Legal Business Name): SYNERGY OF MINDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2018
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N RIDGEWOOD DR
SEBRING FL
33870-7205
US

IV. Provider business mailing address

320 N RIDGEWOOD DR
SEBRING FL
33870-7205
US

V. Phone/Fax

Practice location:
  • Phone: 305-851-1732
  • Fax:
Mailing address:
  • Phone: 863-576-9091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LOURDES TRIANA
Title or Position: OWNER
Credential:
Phone: 863-576-9091