Basic Information
| Provider Information | |||||||||
| NPI: | 1669896189 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUMMIT CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 YGNACIO VALLEY RD | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945963849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259397500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 700 YGNACIO VALLEY RD | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945963849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259397500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2014 | ||||||||
| LastUpdateDate: | 02/05/2014 | ||||||||
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| AuthorizedOfficialLastName: | PETERS | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9259397500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.