Provider Demographics
NPI:1619181757
Name:SUMMIT COUNSELING SERVICES PC
Entity type:Organization
Organization Name:SUMMIT COUNSELING SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT - OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:H
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:574-286-0030
Mailing Address - Street 1:53658 MARK DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:IN
Mailing Address - Zip Code:46507-9710
Mailing Address - Country:US
Mailing Address - Phone:574-286-0030
Mailing Address - Fax:574-234-1994
Practice Address - Street 1:928 E WAYNE ST
Practice Address - Street 2:SUITE C
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-3024
Practice Address - Country:US
Practice Address - Phone:574-286-0030
Practice Address - Fax:574-234-1994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20010389A103TC0700X
IN34004946A1041C0700X
IN34004850A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000373890OtherANTHEM GROUP NUMBER
IN000000373892OtherANTHEM INDIV PROVIDER #
IN000000393533OtherANTHEM INDIV PROVIDER #
IN000000485220OtherANTHEM INDIV PROVIDER #