Healthcare Provider Details

I. General information

NPI: 1700833555
Provider Name (Legal Business Name): SUMMIT POINTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 MICHIGAN AVE W
BATTLE CREEK MI
49017-3602
US

IV. Provider business mailing address

8472 RELIABLE PARKWY
CHICAGO IL
60686-0001
US

V. Phone/Fax

Practice location:
  • Phone: 269-966-1460
  • Fax: 269-966-2844
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ERVIN BRINKER
Title or Position: CEO
Credential:
Phone: 269-966-1460