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General NPI Number Information
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NPI Number | 1497568174
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Entity Type | Organization
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Legal Business Name | SUMMIT PSYCHIATRY ASSOCIATES
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Dates
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Enumeration Date | 01/28/2025
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 247 S ALASKA ST
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City | PALMER
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State | AK
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Zip | 99645-6335
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Country | US
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Telephone | 907-215-2353
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Fax | 907-931-6135
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Provider Business Mailing Address
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Address Line | 247 S ALASKA ST
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City | PALMER
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State | AK
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Zip | 99645-6335
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Country | US
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Telephone | 907-215-2353
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. CHRISTOPHER DAVID DIETRICH
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Credential | PA-C
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Telephone | 509-551-1174
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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