Healthcare Provider Details

I. General information

NPI: 1689203515
Provider Name (Legal Business Name): NEW SUMMIT BEHAVIORAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 GREEN ACRES RD # 102-360
EUGENE OR
97408-1505
US

IV. Provider business mailing address

1056 GREEN ACRES RD # 102-360
EUGENE OR
97408-1505
US

V. Phone/Fax

Practice location:
  • Phone: 951-675-5470
  • Fax:
Mailing address:
  • Phone: 541-224-6987
  • Fax: 541-225-4628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: EVAN GREGORY RYERSON
Title or Position: FOUNDER
Credential: MA, BCBA, LBA
Phone: 951-675-5470