Provider Demographics
NPI:1063920619
Name:ENSYNC PARTNERSHIPS
Entity type:Organization
Organization Name:ENSYNC PARTNERSHIPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA, NCC, BC-TMH, LPC
Authorized Official - Phone:904-750-1229
Mailing Address - Street 1:6327 COVENTRY DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-7914
Mailing Address - Country:US
Mailing Address - Phone:904-750-1229
Mailing Address - Fax:
Practice Address - Street 1:2323 S TROY ST STE 3-107
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1982
Practice Address - Country:US
Practice Address - Phone:314-541-6256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-17
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0013572101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO900143944Medicaid