Provider Demographics
NPI:1013579044
Name:SUMMIT ALLIED BEHAVIORAL SERVICES, LLC
Entity Type:Organization
Organization Name:SUMMIT ALLIED BEHAVIORAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:970-368-2344
Mailing Address - Street 1:99 AUDREY CIR
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80424-8950
Mailing Address - Country:US
Mailing Address - Phone:970-368-2344
Mailing Address - Fax:
Practice Address - Street 1:99 AUDREY CIR
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:CO
Practice Address - Zip Code:80424-8950
Practice Address - Country:US
Practice Address - Phone:970-368-2344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-29
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty