Provider Demographics
NPI:1093856494
Name:DOUGLAS R PRINCEHORN SUMMIT THERAPY CENTER
Entity Type:Organization
Organization Name:DOUGLAS R PRINCEHORN SUMMIT THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CHEVELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-464-6907
Mailing Address - Street 1:4419 CLEVELAND RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-1233
Mailing Address - Country:US
Mailing Address - Phone:330-345-8450
Mailing Address - Fax:330-345-5899
Practice Address - Street 1:4419 CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-1233
Practice Address - Country:US
Practice Address - Phone:330-345-8450
Practice Address - Fax:330-345-5899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0008036101Y00000X
OHI7261101Y00000X
OHS-0018817104100000X
OHS-0012173104100000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty