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General NPI Number Information
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NPI Number | 1780409995
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Entity Type | Organization
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Legal Business Name | SYNERGY ELEVATION GROUP LLC
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 12605 EAST FWY STE 308
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City | HOUSTON
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State | TX
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Zip | 77015-5646
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Country | US
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Telephone | 575-430-3990
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Fax |
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Provider Business Mailing Address
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Address Line | 10502 E COUNTY ROAD 104
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City | MIDLAND
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State | TX
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Zip | 79706-5374
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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 | OWNER
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Name | WILLIAM HARVEY
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Credential |
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Telephone | 575-430-3990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional 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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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