Provider Demographics
NPI:1073024196
Name:SUMMIT BEHAVIORAL CONSULTING LLC
Entity Type:Organization
Organization Name:SUMMIT BEHAVIORAL CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:WIKE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:804-436-2222
Mailing Address - Street 1:529 ARROYO SECO
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3145
Mailing Address - Country:US
Mailing Address - Phone:804-436-2222
Mailing Address - Fax:
Practice Address - Street 1:529 ARROYO SECO
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3145
Practice Address - Country:US
Practice Address - Phone:804-436-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty