Provider Demographics
NPI:1538475595
Name:SUMMITVIEW BEHAVIORAL HEALTH PLLC
Entity Type:Organization
Organization Name:SUMMITVIEW BEHAVIORAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLLC MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:KILLPACK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:956-639-6309
Mailing Address - Street 1:74 TUDELA ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-1870
Mailing Address - Country:US
Mailing Address - Phone:956-639-6309
Mailing Address - Fax:
Practice Address - Street 1:74 TUDELA ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-1870
Practice Address - Country:US
Practice Address - Phone:956-639-6309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20280101YP2500X
TX62062101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty