Provider Demographics
NPI:1346513884
Name:SUMMIT COUNSELING
Entity Type:Organization
Organization Name:SUMMIT COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:DELIA
Authorized Official - Last Name:AVOY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:719-310-0247
Mailing Address - Street 1:25 N WAHSATCH AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3490
Mailing Address - Country:US
Mailing Address - Phone:719-310-0247
Mailing Address - Fax:719-684-7703
Practice Address - Street 1:25 N WAHSATCH AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3490
Practice Address - Country:US
Practice Address - Phone:719-310-0247
Practice Address - Fax:719-684-7703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9918901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1104816693OtherLCSW