Healthcare Provider Details

I. General information

NPI: 1609799683
Provider Name (Legal Business Name): SUMMIT PSYCHIATRY & COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 NW 99TH AVE
PORTLAND OR
97229-6323
US

IV. Provider business mailing address

119 NW 99TH AVE
PORTLAND OR
97229-6323
US

V. Phone/Fax

Practice location:
  • Phone: 817-368-1106
  • Fax:
Mailing address:
  • Phone: 817-368-1106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN RYAN FORDYCE
Title or Position: PMHNP-BC, FNP-C
Credential: DNP
Phone: 817-368-1106