1396180972 NPI number — JEANNE A. FIELD MILLER D/B/A SUMMERHILL COUNSELING CENTER

Table of content: (NPI 1396180972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396180972 NPI number — JEANNE A. FIELD MILLER D/B/A SUMMERHILL COUNSELING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEANNE A. FIELD MILLER D/B/A 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:
Provider Other Organization Name Type Code:
6
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:
1396180972
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2013
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:
05/08/2013

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:
OWNER
Authorized Official Telephone Number:
903-792-8887

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , with the licence number:  11296 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0405X , with the licence number: 4172 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X , with the licence number: P408022 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X , with the licence number: 003299-030394 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X , with the licence number: 9571 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 80816L . This is a "BCBS OF TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 100978 . This is a "OASIS BEHAVIORAL HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 98096 . This is a "BCBS OF AR" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 119588 . This is a "MULTIPLAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 126784 . This is a "COMPSYCH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 095309302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201640 . This is a "VALUE OPTIONS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 62-08018 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2050566 . This is a "CIGNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 7887121 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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