Healthcare Provider Details

I. General information

NPI: 1902391279
Provider Name (Legal Business Name): SUMMIT COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2029 VANESTA PL STE 8
MANHATTAN KS
66503-7400
US

IV. Provider business mailing address

2029 VANESTA PL STE 8
MANHATTAN KS
66503-7400
US

V. Phone/Fax

Practice location:
  • Phone: 785-477-0101
  • Fax: 785-396-4399
Mailing address:
  • Phone: 785-477-0101
  • Fax: 785-396-4399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4283
License Number StateKS

VII. Legacy identifiers

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

VIII. Authorized Official

Name: ADAM SETH MCCAFFREY
Title or Position: THERAPIST
Credential: LSCSW
Phone: 785-477-0101