Healthcare Provider Details

I. General information

NPI: 1225944556
Provider Name (Legal Business Name): SUMMIT BEHAVIOR COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120B SANTA MARGARITA AVENUE SUITE 211
MENLO PARK CA
94025
US

IV. Provider business mailing address

2261 MARKET ST STE 46078
SAN FRANCISCO CA
94114-1612
US

V. Phone/Fax

Practice location:
  • Phone: 815-529-1104
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MS. GABRIELLE FAIRBAIRN
Title or Position: FOUNDER
Credential: MA, BCBA
Phone: 815-529-1104