Provider Demographics
NPI:1295494706
Name:SYNERGY MENTAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:SYNERGY MENTAL HEALTH SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC-S, CCLS
Authorized Official - Phone:419-575-5830
Mailing Address - Street 1:2111 E WOOSTER ST STE A1
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-9083
Mailing Address - Country:US
Mailing Address - Phone:419-575-5830
Mailing Address - Fax:
Practice Address - Street 1:1021 REVERE DR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-1224
Practice Address - Country:US
Practice Address - Phone:419-556-6807
Practice Address - Fax:419-643-9210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-12
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0195981Medicaid