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General NPI Number Information
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NPI Number | 1033127444
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Entity Type | Organization
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Legal Business Name | SYNERGY COUNSELING SERVICES, INC
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 09/01/2009
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Provider Practice Location Address
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Address Line | 1415 EAST GREEN BAY ST. SUITE 191
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City | SHAWANO
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State | WI
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Zip | 54166-3881
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Country | US
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Telephone | 715-526-5466
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Fax | 715-526-5545
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Provider Business Mailing Address
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Address Line | 1415 EAST GREEN BAY ST. SUITE 191
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City | SHAWANO
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State | WI
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Zip | 54166-3881
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Country | US
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Telephone | 715-526-5466
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Fax | 715-526-5545
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. NEIL C. VANROSSUM
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Credential | MS
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Telephone | 715-526-5466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 1895
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 1896
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 1894
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1802057
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License Number State | WI
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Taxonomy #5
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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