Provider Demographics
NPI:1598587263
Name:SYNERGISTIC BODY AND MIND
Entity type:Organization
Organization Name:SYNERGISTIC BODY AND MIND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXINE
Authorized Official - Middle Name:NMN
Authorized Official - Last Name:WILBORN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, PHD
Authorized Official - Phone:408-656-2355
Mailing Address - Street 1:221 HICKORY RUN
Mailing Address - Street 2:
Mailing Address - City:LA VERNIA
Mailing Address - State:TX
Mailing Address - Zip Code:78121-4584
Mailing Address - Country:US
Mailing Address - Phone:408-656-2355
Mailing Address - Fax:
Practice Address - Street 1:1603 BABCOCK RD STE 238-5
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4708
Practice Address - Country:US
Practice Address - Phone:408-903-6425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty