Provider Demographics
NPI:1912540519
Name:SUMMIT WELLNESS COUNSELING, LLC
Entity Type:Organization
Organization Name:SUMMIT WELLNESS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, QMHP
Authorized Official - Phone:541-203-6698
Mailing Address - Street 1:1717 CENTENNIAL BLVD STE 12
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-3378
Mailing Address - Country:US
Mailing Address - Phone:541-203-6698
Mailing Address - Fax:541-229-1285
Practice Address - Street 1:1717 CENTENNIAL BLVD STE 12
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-3378
Practice Address - Country:US
Practice Address - Phone:541-203-6698
Practice Address - Fax:541-229-1285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-26
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)