Provider Demographics
NPI:1326414350
Name:SYNERGY RECOVERY CENTER
Entity type:Organization
Organization Name:SYNERGY RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LOETHEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:417-812-4440
Mailing Address - Street 1:3955 S FARM ROAD 223
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65742-8807
Mailing Address - Country:US
Mailing Address - Phone:417-812-4440
Mailing Address - Fax:417-208-5880
Practice Address - Street 1:3955 S FARM ROAD 223
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65742-8807
Practice Address - Country:US
Practice Address - Phone:417-812-4440
Practice Address - Fax:417-208-5880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008002505324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility