Provider Demographics
NPI:1689203515
Name:NEW SUMMIT BEHAVIORAL THERAPY, LLC
Entity Type:Organization
Organization Name:NEW SUMMIT BEHAVIORAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:RYERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA, LBA
Authorized Official - Phone:951-675-5470
Mailing Address - Street 1:1056 GREEN ACRES RD # 102-360
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-1505
Mailing Address - Country:US
Mailing Address - Phone:951-675-5470
Mailing Address - Fax:
Practice Address - Street 1:1056 GREEN ACRES RD # 102-360
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-1505
Practice Address - Country:US
Practice Address - Phone:951-675-5470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health