Healthcare Provider Details

I. General information

NPI: 1619181757
Provider Name (Legal Business Name): SUMMIT COUNSELING SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 E WAYNE ST SUITE C
SOUTH BEND IN
46617-3024
US

IV. Provider business mailing address

53658 MARK DR
BRISTOL IN
46507-9710
US

V. Phone/Fax

Practice location:
  • Phone: 574-286-0030
  • Fax: 574-234-1994
Mailing address:
  • Phone: 574-286-0030
  • Fax: 574-234-1994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20010389A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34004946A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34004850A
License Number StateIN

VIII. Authorized Official

Name: NANCY H BRYANT
Title or Position: PRESIDENT - OWNER
Credential: LCSW
Phone: 574-286-0030