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General NPI Number Information
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NPI Number | 1487114385
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Entity Type | Organization
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Legal Business Name | SUMMIT BEHAVIORAL SOLUTIONS, LLC
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Dates
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Enumeration Date | 03/25/2019
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 1102 E MAIN
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City | PUYALLUP
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State | WA
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Zip | 98372-3127
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Country | US
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Telephone | 253-339-6094
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Fax | 253-251-0716
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Provider Business Mailing Address
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Address Line | 1102 E MAIN
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City | PUYALLUP
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State | WA
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Zip | 98372-3127
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Country | US
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Telephone | 253-339-6094
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Fax | 253-251-0716
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Authorized Official
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Title or Position | OWNER
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Name | ANGELINA LEASE
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Credential | BCBA
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Telephone | 337-353-3726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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