Provider Demographics
NPI:1235911579
Name:SUMMIT THERAPY LLC
Entity Type:Organization
Organization Name:SUMMIT THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MINIARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:619-436-7157
Mailing Address - Street 1:6920 43RD LOOP SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-7114
Mailing Address - Country:US
Mailing Address - Phone:619-436-7157
Mailing Address - Fax:
Practice Address - Street 1:700 SLEATER KINNEY RD SE STE B189
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1150
Practice Address - Country:US
Practice Address - Phone:619-436-7157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-20
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty