Provider Demographics
NPI:1679860746
Name:SYRINGA PSYCHOTHERAPY
Entity type:Organization
Organization Name:SYRINGA PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:RICHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-946-5242
Mailing Address - Street 1:212 N 1ST AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1436
Mailing Address - Country:US
Mailing Address - Phone:208-946-5242
Mailing Address - Fax:
Practice Address - Street 1:212 N 1ST AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1436
Practice Address - Country:US
Practice Address - Phone:208-946-5242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-4465251S00000X
IDLPC-4235251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health