Healthcare Provider Details

I. General information

NPI: 1669896189
Provider Name (Legal Business Name): SUMMIT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 YGNACIO VALLEY RD SUITE 320
WALNUT CREEK CA
94596-3849
US

IV. Provider business mailing address

700 YGNACIO VALLEY RD SUITE 320
WALNUT CREEK CA
94596-3849
US

V. Phone/Fax

Practice location:
  • Phone: 925-939-7500
  • Fax:
Mailing address:
  • Phone: 925-939-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MS. ELIZABETH PETERS
Title or Position: OWNER
Credential:
Phone: 925-939-7500