1710342746 NPI number — SUMMIT COUNSELING AND COACHING LLC

Table of content: (NPI 1710342746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710342746 NPI number — SUMMIT COUNSELING AND COACHING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMMIT COUNSELING AND COACHING LLC
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:
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:
1710342746
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10305 DAWSONS CREEK BLVD
Provider Second Line Business Mailing Address:
STE C
Provider Business Mailing Address City Name:
FORT WAYNE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46825-1914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-710-8175
Provider Business Mailing Address Fax Number:
260-710-8176

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10305 DAWSONS CREEK BLVD
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
FORT WAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46825-1914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-710-8175
Provider Business Practice Location Address Fax Number:
260-710-8176
Provider Enumeration Date:
12/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
K.
Authorized Official Middle Name:
RANDALL
Authorized Official Title or Position:
OWNER/PROVIDER/PRESIDENT
Authorized Official Telephone Number:
260-710-8175

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  39002091A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com