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General NPI Number Information
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NPI Number | 1033702360
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Entity Type | Organization
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Legal Business Name | SYNAPSE INTEGRATED PSYCHOLOGY, LLC
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Dates
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Enumeration Date | 02/17/2021
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Last Update Date | 06/14/2021
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Provider Practice Location Address
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Address Line | 303 S FIRST ST
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City | GALLUP
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State | NM
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Zip | 87301-6211
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Country | US
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Telephone | 505-397-7197
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Fax |
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Provider Business Mailing Address
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Address Line | 303 S FIRST ST
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City | GALLUP
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State | NM
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Zip | 87301-6211
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Country | US
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Telephone | 505-488-2807
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Fax | 844-502-0999
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Authorized Official
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Title or Position | MEMBER/ OWNER
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Name | JULIANA MARIE STRAVERS
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Credential | LLPC, LPC
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Telephone | 616-502-9681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number |
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License Number State |
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