Provider Demographics
NPI:1134491046
Name:SUMMIT BEHAVIORAL HEALTH PLLC
Entity Type:Organization
Organization Name:SUMMIT BEHAVIORAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RADHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:KAMBHAMPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-655-9121
Mailing Address - Street 1:4100 FAIRWAY DR
Mailing Address - Street 2:BLDG # 200
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-6525
Mailing Address - Country:US
Mailing Address - Phone:972-655-9121
Mailing Address - Fax:888-298-9121
Practice Address - Street 1:4100 FAIRWAY DR
Practice Address - Street 2:BLDG # 200
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-6525
Practice Address - Country:US
Practice Address - Phone:972-655-9121
Practice Address - Fax:888-298-9121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH90992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB150119Medicare PIN