MEDICARE: SUMMITSTONE HEALTH PARTNERS

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1831935626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMITSTONE HEALTH PARTNERS

Provider Business Mailing Address
First Line	:	4856 INNOVATION DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5539
Country	:	US
Telephone Number	:	970-494-4200
Fax Number	:	844-270-1824

Provider Business Practice Location Address
First Line	:	5080 FOSSIL BLVD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-4034
Country	:	US
Telephone Number	:	970-494-4200
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CYNTHIA DODDS
Credential	:	LMFT
Telephone Number	:	970-494-4200

Provider Enumeration Date	:	07/02/2024
Last Update Date	:	11/11/2024

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