Provider Demographics
NPI:1215572649
Name:SUMMIT PSYCHOTHERAPY
Entity type:Organization
Organization Name:SUMMIT PSYCHOTHERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ERICH
Authorized Official - Middle Name:H
Authorized Official - Last Name:HEINTZEN
Authorized Official - Suffix:IV
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-612-6206
Mailing Address - Street 1:5842 N WAYNE AVE APT G
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1981
Mailing Address - Country:US
Mailing Address - Phone:773-612-6206
Mailing Address - Fax:
Practice Address - Street 1:4753 N BROADWAY ST STE 1014
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4990
Practice Address - Country:US
Practice Address - Phone:773-612-6206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-08
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty