Provider Demographics
NPI:1124313481
Name:SYNERGISM COUNSELING, LLC
Entity type:Organization
Organization Name:SYNERGISM COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:H
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-350-1671
Mailing Address - Street 1:PO BOX 1292
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:UT
Mailing Address - Zip Code:84049-1292
Mailing Address - Country:US
Mailing Address - Phone:801-350-1671
Mailing Address - Fax:801-446-6511
Practice Address - Street 1:11075 S STATE ST STE 16
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-5196
Practice Address - Country:US
Practice Address - Phone:801-350-1671
Practice Address - Fax:801-446-6511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty