Healthcare Provider Details

I. General information

NPI: 1619772852
Provider Name (Legal Business Name): SUMMIT PSYCHOTHERAPY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 PACIFICA STE 450
IRVINE CA
92618-3343
US

IV. Provider business mailing address

PO BOX 561482
DENVER CO
80256-1482
US

V. Phone/Fax

Practice location:
  • Phone: 877-825-8584
  • Fax:
Mailing address:
  • Phone: 303-731-8164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MISS JESS JOSLIN
Title or Position: MANAGER, CREDENTIALING & PAYOR STRA
Credential:
Phone: 303-731-8164