Provider Demographics
NPI:1609632322
Name:SUMMIT MENTAL HEALTH, LLC.
Entity Type:Organization
Organization Name:SUMMIT MENTAL HEALTH, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLVARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-850-0105
Mailing Address - Street 1:9715 S 31ST WEST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-3802
Mailing Address - Country:US
Mailing Address - Phone:918-850-0105
Mailing Address - Fax:
Practice Address - Street 1:7804 E 108TH ST STE C
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-7422
Practice Address - Country:US
Practice Address - Phone:918-850-0105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty