Provider Demographics
NPI:1760367569
Name:SUMMIT THERAPY LLC
Entity type:Organization
Organization Name:SUMMIT THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MINIARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:907-978-1943
Mailing Address - Street 1:700 SLEATER KINNEY RD SE STE B189
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1150
Mailing Address - Country:US
Mailing Address - Phone:907-978-1943
Mailing Address - Fax:
Practice Address - Street 1:3768 GRAY FOX DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-6236
Practice Address - Country:US
Practice Address - Phone:907-978-1943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT THERAPY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty