Provider Demographics
NPI:1609415199
Name:SUMMIT CREEK COUNSELING LLC
Entity Type:Organization
Organization Name:SUMMIT CREEK COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JODIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:208-220-6534
Mailing Address - Street 1:PO BOX 35
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:ID
Mailing Address - Zip Code:83234-0035
Mailing Address - Country:US
Mailing Address - Phone:208-220-6534
Mailing Address - Fax:
Practice Address - Street 1:57 BANNOCK ST
Practice Address - Street 2:
Practice Address - City:MALAD CITY
Practice Address - State:ID
Practice Address - Zip Code:83252-1240
Practice Address - Country:US
Practice Address - Phone:208-220-6534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty