=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457767832
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SYNERGY COUNSELING SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2014
-----------------------------------------------------
Last Update Date | 01/09/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33300 WARREN RD STE 19
-----------------------------------------------------
City | WESTLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48185-9627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-799-7646
-----------------------------------------------------
Fax | 734-661-6786
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33300 WARREN RD STE 19
-----------------------------------------------------
City | WESTLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48185-9627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-799-7351
-----------------------------------------------------
Fax | 734-744-6833
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MISS BECKY SUE BRANT
-----------------------------------------------------
Credential | LMSW
-----------------------------------------------------
Telephone | 734-799-7351
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 6401012582
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 6801092432
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------