Healthcare Provider Details

I. General information

NPI: 1285436949
Provider Name (Legal Business Name): SUMMIT WELLNESS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9582 HILL RD
KLAMATH FALLS OR
97603-9729
US

IV. Provider business mailing address

9582 HILL RD
KLAMATH FALLS OR
97603-9729
US

V. Phone/Fax

Practice location:
  • Phone: 541-505-4468
  • Fax:
Mailing address:
  • Phone: 541-505-4468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: DEANNA PADGET
Title or Position: OWNER
Credential:
Phone: 541-887-0136