Provider Demographics
NPI:1548274863
Name:SUMMIT CENTER FOR MENTAL HEALTH INC
Entity type:Organization
Organization Name:SUMMIT CENTER FOR MENTAL HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:815-773-0772
Mailing Address - Street 1:3033 W JEFFERSON ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5261
Mailing Address - Country:US
Mailing Address - Phone:815-773-0772
Mailing Address - Fax:815-773-0771
Practice Address - Street 1:3033 W JEFFERSON ST
Practice Address - Street 2:SUITE 107
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5261
Practice Address - Country:US
Practice Address - Phone:815-773-0772
Practice Address - Fax:815-773-0771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.004989101YP2500X
IL180.003022101YP2500X
IL180.005943101YP2500X
IL149.0129851041C0700X
IL149.0115891041C0700X
IL149.0121201041C0700X
IL149.0108881041C0700X
IL149.0105941041C0700X
IL149.0072911041C0700X
IL149.0037111041C0700X
IL149.0104901041C0700X
IL166.000735106H00000X
IL036.1269802084P0804X
IL036.1203032084P0805X
IL180.004322101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL405800Medicare ID - Type Unspecified
IL213997Medicare PIN