Provider Demographics
NPI:1114701679
Name:SUMMIT BEHAVIOR SUPPORT
Entity Type:Organization
Organization Name:SUMMIT BEHAVIOR SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALYSHA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:STOWE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:509-741-0253
Mailing Address - Street 1:31086 N 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:ID
Mailing Address - Zip Code:83869-9475
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2700 E SELTICE WAY STE 8
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-7986
Practice Address - Country:US
Practice Address - Phone:509-741-0253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty