Provider Demographics
NPI:1356677694
Name:MASATA, INC.
Entity Type:Organization
Organization Name:MASATA, INC.
Other - Org Name:SUMMIT COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR, THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:C.
Authorized Official - Middle Name:NATHAN
Authorized Official - Last Name:MCANELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, CSW
Authorized Official - Phone:606-787-1950
Mailing Address - Street 1:PO BOX 1116
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:42539-1116
Mailing Address - Country:US
Mailing Address - Phone:606-787-1950
Mailing Address - Fax:606-787-0123
Practice Address - Street 1:549 MIDDLEBURG ST.
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:42539
Practice Address - Country:US
Practice Address - Phone:606-787-1950
Practice Address - Fax:606-787-0123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY810273251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health