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General NPI Number Information
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NPI Number | 1063288348
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Entity Type | Organization
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Legal Business Name | SUMMIT THERAPY LLC
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Dates
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Enumeration Date | 11/28/2023
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 250 CUSHMAN ST STE 4F
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City | FAIRBANKS
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State | AK
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Zip | 99701-4665
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Country | US
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Telephone | 907-978-1943
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Fax | 360-838-4806
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Provider Business Mailing Address
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Address Line | 700 SLEATER KINNEY RD SE STE B189
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City | LACEY
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State | WA
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Zip | 98503-1150
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Country | US
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Telephone | 907-978-1943
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Fax | 360-838-4806
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | CARRIE L MINIARD
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Credential | LCSW
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Telephone | 907-978-1943
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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