Provider Demographics
NPI:1396370094
Name:SUMMIT PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:SUMMIT PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALIFEH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, ABPP
Authorized Official - Phone:303-256-5408
Mailing Address - Street 1:6200 S SYRACUSE WAY STE 260
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4739
Mailing Address - Country:US
Mailing Address - Phone:303-805-5456
Mailing Address - Fax:
Practice Address - Street 1:6200 S SYRACUSE WAY STE 260
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-4739
Practice Address - Country:US
Practice Address - Phone:303-805-5456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-03
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty