NPI Code Detail JSON Logo

1134913379 NPI number — SYNAPSE COLLABORATIVE LLC

NPI Number: 1134913379
Health Care Provider/Practitioner: SYNAPSE COLLABORATIVE LLC

Information about “1134913379” NPI (SYNAPSE COLLABORATIVE LLC) exists in 1134913379 in HTML format HTML  |  1134913379 in plain Text format TXT  |  1134913379 in PDF (Portable Document Format) PDF  |  1134913379 in an XML format XML  formats.

NPI Number : 1134913379 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1134913379",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SYNAPSE COLLABORATIVE LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1235 CEDAR CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CARBONDALE",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "62901-5335",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "618-467-8805",
    "MailingAddressFaxNumber": "618-766-8073",
    "FirstLinePracticeLocationAddress": "1235 CEDAR CT",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CARBONDALE",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "62901-5335",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "618-467-8805",
    "PracticeLocationAddressFaxNumber": "618-766-8073",
    "EnumerationDate": "04/04/2025",
    "LastUpdateDate": "06/02/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MCKINNEY",
    "AuthorizedOfficialFirstName": "AMANDA",
    "AuthorizedOfficialMiddleName": "LYN",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PSYD, LCP",
    "AuthorizedOfficialTelephoneNumber": "618-467-8805",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103T00000X",
          "TaxonomyName": "Psychologist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TS0200X",
          "TaxonomyName": "School Psychologist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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