Healthcare Provider Details

I. General information

NPI: 1235593708
Provider Name (Legal Business Name): SUMMIT COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 04/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 14TH ST W STE 290
WILLISTON ND
58801-4078
US

IV. Provider business mailing address

1500 14TH ST W STE 290
WILLISTON ND
58801-4078
US

V. Phone/Fax

Practice location:
  • Phone: 701-334-6242
  • Fax: 701-712-3299
Mailing address:
  • Phone: 701-334-6242
  • Fax: 701-712-3299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number4755
License Number StateND

VIII. Authorized Official

Name: MRS. BRENDA LEE OWEN
Title or Position: OWNER/THERAPIST
Credential: LAC, MSW, LICSW
Phone: 701-334-6242