MEDICARE: SUMMIT BEHAVIORAL HEALTH PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1497370258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT BEHAVIORAL HEALTH PLLC

Provider Business Mailing Address
First Line	:	8110 S HOUGHTON RD
Second Line	:	STE 158 PMB 136
City	:	TUCSON
State	:	AZ
Zip	:	85747
Country	:	US
Telephone Number	:	520-468-9844
Fax Number	:

Provider Business Practice Location Address
First Line	:	8230 E BROADWAY BLVD STE E7
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-4002
Country	:	US
Telephone Number	:	520-468-9844
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MISTY MCGILLEM
Credential	:	DNP
Telephone Number	:	520-468-9844

Provider Enumeration Date	:	06/08/2020
Last Update Date	:	03/14/2024

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