1629279534 NPI number — JEANNE A. FIELD MILLER DOING BUSINESS AS SUMMERHILL COUNSELING CENTER

Table of content: (NPI 1629279534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629279534 NPI number — JEANNE A. FIELD MILLER DOING BUSINESS AS SUMMERHILL COUNSELING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEANNE A. FIELD MILLER DOING BUSINESS AS SUMMERHILL COUNSELING CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SUMMERHILL COUNSELING CENTER
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629279534
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4091 SUMMERHILL SQ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEXARKANA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75503-2768
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-792-8887
Provider Business Mailing Address Fax Number:
903-792-8799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4091 SUMMERHILL SQ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEXARKANA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75503-2768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-792-8887
Provider Business Practice Location Address Fax Number:
903-792-8799
Provider Enumeration Date:
05/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FIELD MILLER
Authorized Official First Name:
JEANNE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
COUNSELOR
Authorized Official Telephone Number:
903-792-8887

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  4172 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YP2500X , with the licence number: 11296 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YP2500X , with the licence number: P08022 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 106H00000X , with the licence number: 0032990-030394 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 201640 . This is a "VALUE OPTIONS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 119588 . This is a "SUPERIOR HEALTH INSURANCE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 98096 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 80816L . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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