Provider Demographics
NPI:1710342746
Name:SUMMIT COUNSELING AND COACHING LLC
Entity Type:Organization
Organization Name:SUMMIT COUNSELING AND COACHING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:K.
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:260-710-8175
Mailing Address - Street 1:10305 DAWSONS CREEK BLVD
Mailing Address - Street 2:STE C
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1914
Mailing Address - Country:US
Mailing Address - Phone:260-710-8175
Mailing Address - Fax:260-710-8176
Practice Address - Street 1:10305 DAWSONS CREEK BLVD
Practice Address - Street 2:STE C
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1914
Practice Address - Country:US
Practice Address - Phone:260-710-8175
Practice Address - Fax:260-710-8176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002091A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty