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General NPI Number Information
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NPI Number | 1902290232
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Entity Type | Organization
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Legal Business Name | SYNERGY ABA
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Dates
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Enumeration Date | 03/25/2015
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Last Update Date | 12/22/2015
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Provider Practice Location Address
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Address Line | 7542 TRENTON AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63130-1316
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Country | US
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Telephone | 314-254-3591
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Fax |
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Provider Business Mailing Address
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Address Line | 7542 TRENTON AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63130-1316
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Country | US
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Telephone | 314-254-3591
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BRANDON MAY
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Credential | BCBA, LBA
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Telephone | 314-254-3591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2014011930
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 2014011930
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 2014011930
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License Number State | MO
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