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General NPI Number Information
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NPI Number | 1386166791
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Entity Type | Organization
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Legal Business Name | SUMMIT FAMILY COUNSELING, INC.
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Dates
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Enumeration Date | 07/07/2017
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Last Update Date | 07/07/2017
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Provider Practice Location Address
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Address Line | 7 HALSTED CIR
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City | ROGERS
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State | AR
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Zip | 72756-3185
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Country | US
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Telephone | 479-270-9129
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Fax |
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Provider Business Mailing Address
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Address Line | 7 HALSTED CIR STE 104
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City | ROGERS
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State | AR
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Zip | 72756-3185
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Country | US
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Telephone | 479-270-9129
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DANIEL RAY LUTTRELL
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Credential | LPC, LMFT
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Telephone | 479-270-9129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | P1509096
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License Number State | AR
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