Provider Demographics
NPI:1114382850
Name:SUMMIT MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:SUMMIT MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHLEA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:352-638-6639
Mailing Address - Street 1:214 E WASHINGTON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34715-9227
Mailing Address - Country:US
Mailing Address - Phone:356-638-6639
Mailing Address - Fax:352-243-0812
Practice Address - Street 1:214 E WASHINGTON ST
Practice Address - Street 2:SUITE A
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715-9227
Practice Address - Country:US
Practice Address - Phone:356-638-6639
Practice Address - Fax:352-243-0812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW6891251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW6891OtherFLORIDA DEPARTMENT OF HEALTH