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General NPI Number Information
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NPI Number | 1275186058
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Entity Type | Organization
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Legal Business Name | SYNERGY COUNSELING LLC
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Dates
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Enumeration Date | 07/19/2019
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Last Update Date | 07/19/2019
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Provider Practice Location Address
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Address Line | 11219 W RENO AVE STE 1
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City | YUKON
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State | OK
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Zip | 73099-7569
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Country | US
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Telephone | 405-265-8866
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Fax | 405-384-1221
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Provider Business Mailing Address
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Address Line | 11219 W RENO AVE
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City | YUKON
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State | OK
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Zip | 73099-7569
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Country | US
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Telephone | 405-265-8866
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Fax | 405-384-1221
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Authorized Official
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Title or Position | OWNER
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Name | MISSY RIDDLES
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Credential | LPC
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Telephone | 405-265-8866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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