Provider Demographics
NPI:1366588303
Name:SUMMIT EATING DISORDERS AND OUTREACH PROGRAM
Entity type:Organization
Organization Name:SUMMIT EATING DISORDERS AND OUTREACH PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:916-920-5276
Mailing Address - Street 1:601 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6775
Mailing Address - Country:US
Mailing Address - Phone:916-920-5276
Mailing Address - Fax:916-920-5221
Practice Address - Street 1:601 UNIVERSITY AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6775
Practice Address - Country:US
Practice Address - Phone:916-920-5276
Practice Address - Fax:916-920-5221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health