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General NPI Number Information
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NPI Number | 1497370258
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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 | 06/08/2020
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Last Update Date | 03/14/2024
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Provider Practice Location Address
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Address Line | 8230 E BROADWAY BLVD STE E7
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City | TUCSON
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State | AZ
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Zip | 85710-4002
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Country | US
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Telephone | 520-468-9844
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Fax |
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Provider Business Mailing Address
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Address Line | 8110 S HOUGHTON RD STE 158 PMB 136
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City | TUCSON
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State | AZ
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Zip | 85747
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Country | US
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Telephone | 520-468-9844
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MISTY MCGILLEM
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Credential | DNP
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Telephone | 520-468-9844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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