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General NPI Number Information
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NPI Number | 1134913379
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Entity Type | Organization
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Legal Business Name | SYNAPSE COLLABORATIVE LLC
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Dates
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Enumeration Date | 04/04/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 1235 CEDAR CT
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City | CARBONDALE
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State | IL
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Zip | 62901-5335
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Country | US
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Telephone | 618-467-8805
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Fax | 618-766-8073
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Provider Business Mailing Address
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Address Line | 1235 CEDAR CT
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City | CARBONDALE
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State | IL
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Zip | 62901-5335
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Country | US
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Telephone | 618-467-8805
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Fax | 618-766-8073
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Authorized Official
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Title or Position | OWNER
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Name | DR. AMANDA LYN MCKINNEY
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Credential | PSYD, LCP
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Telephone | 618-467-8805
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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 | 103T00000X
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Taxonomy Name | Psychologist
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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