MEDICARE: SUMMIT MENTAL HEALTH & WELLNESS 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	:	1679261176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT MENTAL HEALTH & WELLNESS PLLC

Provider Business Mailing Address
First Line	:	16042 N 32ND ST STE A2
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-0024
Country	:	US
Telephone Number	:	480-300-4761
Fax Number	:	780-903-1607

Provider Business Practice Location Address
First Line	:	16042 N 32ND ST STE A2
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-0024
Country	:	US
Telephone Number	:	480-300-4761
Fax Number	:	780-903-1607

Authorized Official
Title or Position	:	CEO
Name	:	MARILIZABETH BIRK
Credential	:	NP
Telephone Number	:	602-791-9028

Provider Enumeration Date	:	04/24/2023
Last Update Date	:	05/02/2025

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