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General NPI Number Information
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NPI Number | 1538475595
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Entity Type | Organization
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Legal Business Name | SUMMITVIEW BEHAVIORAL HEALTH PLLC
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Dates
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Enumeration Date | 08/27/2010
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Last Update Date | 08/27/2010
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Provider Practice Location Address
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Address Line | 74 TUDELA ST
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City | BROWNSVILLE
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State | TX
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Zip | 78526-1870
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Country | US
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Telephone | 956-639-6309
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Fax |
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Provider Business Mailing Address
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Address Line | 74 TUDELA ST
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City | BROWNSVILLE
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State | TX
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Zip | 78526-1870
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Country | US
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Telephone | 956-639-6309
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Fax |
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Authorized Official
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Title or Position | PLLC MEMBER/MANAGER
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Name | JORDAN B KILLPACK
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Credential | LPC
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Telephone | 956-639-6309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 62062
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 20280
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License Number State | TX
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