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General NPI Number Information
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NPI Number | 1316433402
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Entity Type | Organization
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Legal Business Name | SYNERGY PRACTICE ASSOCIATES
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Dates
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Enumeration Date | 07/02/2018
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Last Update Date | 07/02/2018
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Provider Practice Location Address
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Address Line | 334 W OLD TOWN CT
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City | CHICAGO
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State | IL
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Zip | 60610-7546
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Country | US
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Telephone | 630-710-9494
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Fax |
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Provider Business Mailing Address
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Address Line | 334 W OLD TOWN CT
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City | CHICAGO
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State | IL
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Zip | 60610-7546
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MS. FARAH HUQ
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Credential |
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Telephone | 630-710-9494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 180.010601
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License Number State | IL
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