Provider Demographics
NPI:1659013324
Name:SUMMIT PSYCHOTHERAPY ASSOCIATES, PC
Entity Type:Organization
Organization Name:SUMMIT PSYCHOTHERAPY ASSOCIATES, PC
Other - Org Name:EATING RECOVERY CENTER OF CALIFORNIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACTING AND CREDENTIALING MANAG
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-214-9321
Mailing Address - Street 1:PO BOX 561482
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80256-1482
Mailing Address - Country:US
Mailing Address - Phone:877-825-8584
Mailing Address - Fax:
Practice Address - Street 1:114 PACIFICA, STE #450
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618
Practice Address - Country:US
Practice Address - Phone:877-825-8584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT PSYCHOTHERAPY ASSOCIATES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-12
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No283Q00000XHospitalsPsychiatric Hospital