Provider Demographics
NPI:1053447615
Name:SUMMIT PSYCHOTHERAPY, P.C.
Entity type:Organization
Organization Name:SUMMIT PSYCHOTHERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SANDY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:256-880-7173
Mailing Address - Street 1:3330 L AND N DR SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5380
Mailing Address - Country:US
Mailing Address - Phone:256-880-7173
Mailing Address - Fax:256-880-7178
Practice Address - Street 1:3330 L AND N DR SW
Practice Address - Street 2:SUITE A
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5380
Practice Address - Country:US
Practice Address - Phone:256-880-7173
Practice Address - Fax:256-880-7178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL320101YM0800X
103T00000X
AL0079C104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL56157OtherCIGNA
AL103756OtherVALUE OPTIONS
AL62-78426OtherUBH
AL510-43994SANOtherBCBS
AL5306083OtherAETNA
ALSA1312OtherREGENCE BLUESHIELD
AL008478OtherVALUE OPTIONS
AL4352583OtherAETNA
AL51099449OtherBC-FEP
ALSA7104OtherREGENCE BLUESHIELD
AL2011841OtherCIGNA
AL510-43995SAIOtherBCBS
AL510-99490OtherBCBS-FEP
AL088994OtherVALUE OPTIONS
AL61-69595OtherUBH
AL510-43995SAIOtherBCBS
AL56157OtherCIGNA