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General NPI Number Information
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NPI Number | 1760367569
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Entity Type | Organization
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Legal Business Name | SUMMIT THERAPY LLC
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Dates
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Enumeration Date | 08/11/2025
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 3768 GRAY FOX DR
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City | CLARKSVILLE
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State | TN
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Zip | 37040-6236
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Country | US
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Telephone | 907-978-1943
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Fax |
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Provider Business Mailing Address
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Address Line | 700 SLEATER KINNEY RD SE STE B189
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City | LACEY
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State | WA
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Zip | 98503-1150
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Country | US
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Telephone | 907-978-1943
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARRIE L MINIARD
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Credential | LCSW
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Telephone | 907-978-1943
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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