Provider Demographics
NPI:1821673716
Name:SUMMIT VIEW WELLNESS SERVICES, LLC
Entity Type:Organization
Organization Name:SUMMIT VIEW WELLNESS SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TRENT
Authorized Official - Middle Name:P
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-262-4209
Mailing Address - Street 1:1070 HILINE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2947
Mailing Address - Country:US
Mailing Address - Phone:208-262-4209
Mailing Address - Fax:208-262-4318
Practice Address - Street 1:1070 HILINE RD STE 210
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2947
Practice Address - Country:US
Practice Address - Phone:208-262-4209
Practice Address - Fax:208-262-4318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-12
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)