Provider Demographics
NPI:1063288348
Name:SUMMIT THERAPY LLC
Entity type:Organization
Organization Name:SUMMIT THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MINIARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:907-978-1943
Mailing Address - Street 1:700 SLEATER KINNEY RD SE STE B189
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1150
Mailing Address - Country:US
Mailing Address - Phone:907-978-1943
Mailing Address - Fax:360-838-4806
Practice Address - Street 1:250 CUSHMAN ST STE 4F
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4665
Practice Address - Country:US
Practice Address - Phone:907-978-1943
Practice Address - Fax:360-838-4806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-28
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty