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General NPI Number Information
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NPI Number | 1598017691
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Entity Type | Organization
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Legal Business Name | SYNTHESIS MIND/BODY LLC
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Dates
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Enumeration Date | 10/12/2012
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Last Update Date | 10/12/2012
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Provider Practice Location Address
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Address Line | 121 NE A ST STE A
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City | GRANTS PASS
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State | OR
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Zip | 97526-2111
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Country | US
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Telephone | 541-471-8077
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Fax | 541-471-8074
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Provider Business Mailing Address
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Address Line | 121 NE A ST STE A
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City | GRANTS PASS
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State | OR
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Zip | 97526-2111
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Country | US
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Telephone | 541-471-8077
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Fax | 541-471-8074
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KATHLEEN A HUGHES-KUDA
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Credential | MD
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Telephone | 541-471-8077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 26314
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License Number State | OR
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