Organization
SUMMIT CLINICS PLLC
Active
Other names
Summit Behavioral Health
Organization subpart
No
Provider details
NPI number
Authorized official
VAMSI DWARAM (MANAGER)
(651) 955-6747
Entity
Organization
Contact information
Practice address
2115 COUNTY ROAD D E STE C, MAPLEWOOD, MN 55109-5353
(651) 955-6747
Mailing address
2115 COUNTY ROAD D E STE C100, MAPLEWOOD, MN 55109-5354
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
103TC1900X
Counseling Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0802X
Addiction Psychiatry Physician
—
—
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
—
—
Other
Enumeration date
05/16/2019
Last updated
05/16/2019
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