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General NPI Number Information
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NPI Number | 1134491046
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Entity Type | Organization
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Legal Business Name | SUMMIT BEHAVIORAL HEALTH PLLC
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Dates
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Enumeration Date | 02/08/2012
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Last Update Date | 10/04/2016
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Provider Practice Location Address
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Address Line | 4100 FAIRWAY DR BLDG # 200
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City | CARROLLTON
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State | TX
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Zip | 75010-6525
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Country | US
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Telephone | 972-655-9121
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Fax | 888-298-9121
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Provider Business Mailing Address
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Address Line | 4100 FAIRWAY DR BLDG # 200
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City | CARROLLTON
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State | TX
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Zip | 75010-6525
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Country | US
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Telephone | 972-655-9121
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Fax | 888-298-9121
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Authorized Official
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Title or Position | CEO
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Name | DR. RADHA K. KAMBHAMPATI
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Credential | M.D.
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Telephone | 972-655-9121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | H9099
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License Number State | TX
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