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General NPI Number Information
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NPI Number | 1609077312
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Entity Type | Organization
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Legal Business Name | SUMMIT COUNSELING SERVICES, P.C.
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2677 E 7TH AVE STE 4
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City | FLAGSTAFF
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State | AZ
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Zip | 86004-3739
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Country | US
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Telephone | 928-522-8161
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Fax | 928-522-8161
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Provider Business Mailing Address
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Address Line | 2677 E 7TH AVE STE 4
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City | FLAGSTAFF
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State | AZ
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Zip | 86004-3739
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Country | US
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Telephone | 928-522-8161
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Fax | 928-522-8161
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KONRAD KASERER
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Credential | LPC
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Telephone | 928-522-8161
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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 | LPC-2051
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License Number State | AZ
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