Organization
SYNERGY EXECUTIVE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PAIGE TUCK LPC (EXECUTIVE DIRECTOR)
(417) 551-9192
Entity
Organization
Contact information
Practice address
2608 SMYRNA RD, OZARK, MO 65721-7674
(417) 812-4440
(417) 208-5880
Mailing address
2608 SMYRNA ROAD, OZARK, MO 65721
(417) 838-0894
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2849
DEPT. OF MENTAL HEALTH/DBH
MO
Enumeration date
01/29/2019
Last updated
07/31/2019
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