Healthcare Provider Details

I. General information

NPI: 1124685565
Provider Name (Legal Business Name): SYNERGETICS MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 11/27/2021
Certification Date: 11/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 W CUSTER AVE
HELENA MT
59602-0219
US

IV. Provider business mailing address

PO BOX 5133
HELENA MT
59604-5133
US

V. Phone/Fax

Practice location:
  • Phone: 406-459-1972
  • Fax: 406-502-1265
Mailing address:
  • Phone: 406-459-1972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID A WOJCIECHOWSKI
Title or Position: OWNER/OPERATOR
Credential: LCSW
Phone: 406-475-2060