Provider Demographics
NPI:1407340706
Name:SUMMIT PSYCHOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:SUMMIT PSYCHOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:B
Authorized Official - Last Name:STECKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, LPC
Authorized Official - Phone:580-484-5000
Mailing Address - Street 1:11659 SE MOUNTAIN RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-6736
Mailing Address - Country:US
Mailing Address - Phone:580-484-5000
Mailing Address - Fax:
Practice Address - Street 1:11659 SE MOUNTAIN RIDGE AVE
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-6736
Practice Address - Country:US
Practice Address - Phone:580-484-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4476101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty