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General NPI Number Information
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NPI Number | 1760833206
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Entity Type | Organization
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Legal Business Name | SUMMIT THERAPY GROUP INC
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Dates
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Enumeration Date | 06/27/2016
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Last Update Date | 06/27/2016
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Provider Practice Location Address
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Address Line | 863 N CLEVELAND MASSILLON RD
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City | AKRON
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State | OH
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Zip | 44333-2167
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Country | US
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Telephone | 330-665-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 863 N CLEVELAND MASSILLON RD
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City | AKRON
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State | OH
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Zip | 44333-2167
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Country | US
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Telephone | 330-665-2273
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA RUSSO
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Credential | PHD, LPCC-S
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Telephone | 330-665-2273
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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 |
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License Number State |
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