Healthcare Provider Details

I. General information

NPI: 1760764211
Provider Name (Legal Business Name): SUMMIT COUNSELING & CONSULTING, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2011
Last Update Date: 09/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N PINE ST
ROLLA MO
65401-3141
US

IV. Provider business mailing address

901 N PINE ST P.O. BOX 2212
ROLLA MO
65401-3141
US

V. Phone/Fax

Practice location:
  • Phone: 573-201-7450
  • Fax:
Mailing address:
  • Phone: 573-201-7450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number002689
License Number StateMO

VII. Legacy identifiers

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

VIII. Authorized Official

Name: STEPHEN L DUNAWAY
Title or Position: OWNER
Credential: MSW, LCSW
Phone: 573-201-7450