Provider Demographics
NPI:1497370258
Name:SUMMIT BEHAVIORAL HEALTH PLLC
Entity Type:Organization
Organization Name:SUMMIT BEHAVIORAL HEALTH PLLC
Other - Org Name:SUMMIT BEHAVIORAL HEALTH, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGILLEM
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:520-468-9844
Mailing Address - Street 1:8110 S HOUGHTON RD
Mailing Address - Street 2:STE 158 PMB 136
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747
Mailing Address - Country:US
Mailing Address - Phone:520-468-9844
Mailing Address - Fax:
Practice Address - Street 1:8230 E BROADWAY BLVD STE E7
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-4002
Practice Address - Country:US
Practice Address - Phone:520-468-9844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty