Provider Demographics
NPI:1578951026
Name:SUMMIT COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:SUMMIT COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GOFF
Authorized Official - Middle Name:
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:423-855-0402
Mailing Address - Street 1:6400 LEE HWY STE 106
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2452
Mailing Address - Country:US
Mailing Address - Phone:423-855-0402
Mailing Address - Fax:423-370-1518
Practice Address - Street 1:6400 LEE HWY STE 106
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2452
Practice Address - Country:US
Practice Address - Phone:423-855-0402
Practice Address - Fax:423-370-1518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty