Healthcare Provider Details

I. General information

NPI: 1023939543
Provider Name (Legal Business Name): SUMMIT RECOVERY AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 CANYON CREST DR APT 105
TWIN FALLS ID
83301-8009
US

IV. Provider business mailing address

1935 CANYON CREST DR APT 105
TWIN FALLS ID
83301-8009
US

V. Phone/Fax

Practice location:
  • Phone: 208-841-9622
  • Fax:
Mailing address:
  • Phone: 208-841-9622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: ERIN L DOMINGUEZ
Title or Position: DRUG AND ALCOHOL COUNSELOR
Credential: CADC
Phone: 208-841-9622