Basic Information
| Provider Information | |||||||||
| NPI: | 1366929895 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SYNERGY COUNSELING ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12440 FIRESTONE BLVD STE 201 | ||||||||
| Address2: | |||||||||
| City: | NORWALK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906509323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624500620 | ||||||||
| FaxNumber: | 5623668423 | ||||||||
| Practice Location | |||||||||
| Address1: | 12440 FIRESTONE BLVD STE 201 | ||||||||
| Address2: | |||||||||
| City: | NORWALK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906509323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624500620 | ||||||||
| FaxNumber: | 5623668423 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2018 | ||||||||
| LastUpdateDate: | 12/14/2018 | ||||||||
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| AuthorizedOfficialLastName: | HERNANDEZ | ||||||||
| AuthorizedOfficialFirstName: | BARBARA | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5624500620 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | LMFT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | LMFT46641 | CA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.