Provider Demographics
NPI:1528437142
Name:SYNERGY AUTISM CENTER, LLC
Entity type:Organization
Organization Name:SYNERGY AUTISM CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-432-8760
Mailing Address - Street 1:7739 SW CAPITOL HWY
Mailing Address - Street 2:#220
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-2571
Mailing Address - Country:US
Mailing Address - Phone:503-432-8760
Mailing Address - Fax:
Practice Address - Street 1:7739 SW CAPITOL HWY
Practice Address - Street 2:#220
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2571
Practice Address - Country:US
Practice Address - Phone:503-432-8760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORGRANDFATHERED-IN103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty