Healthcare Provider Details

I. General information

NPI: 1811664022
Provider Name (Legal Business Name): SUMMIT PSYCHOTHERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 FIEDLER AVE STE 207
DILLON CO
80435-6930
US

IV. Provider business mailing address

5402 MONTEZUMA RD
MONTEZUMA CO
80435-7621
US

V. Phone/Fax

Practice location:
  • Phone: 970-200-8563
  • Fax:
Mailing address:
  • Phone: 303-704-8555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: HILLARY SUNDERLAND
Title or Position: OWNER
Credential: LCSW, LAC, EMDR
Phone: 970-200-8563