Provider Demographics
NPI:1013754423
Name:SUMMIT LIFE COUNSELING, PLLC
Entity type:Organization
Organization Name:SUMMIT LIFE COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:817-219-5304
Mailing Address - Street 1:402 MAIN ST # 1198
Mailing Address - Street 2:
Mailing Address - City:PANHANDLE
Mailing Address - State:TX
Mailing Address - Zip Code:79068-3052
Mailing Address - Country:US
Mailing Address - Phone:817-219-5304
Mailing Address - Fax:
Practice Address - Street 1:402 MAIN ST # 1198
Practice Address - Street 2:
Practice Address - City:PANHANDLE
Practice Address - State:TX
Practice Address - Zip Code:79068-3052
Practice Address - Country:US
Practice Address - Phone:817-219-5304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-12
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty