Healthcare Provider Details

I. General information

NPI: 1578444261
Provider Name (Legal Business Name): SUMMIT OUTPATIENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8130 E CACTUS RD STE 510
SCOTTSDALE AZ
85260-5263
US

IV. Provider business mailing address

8130 E CACTUS RD STE 510
SCOTTSDALE AZ
85260-5263
US

V. Phone/Fax

Practice location:
  • Phone: 480-680-7725
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL GOLDMAN
Title or Position: CEO
Credential:
Phone: 480-335-2859