| Name: | Summit Psychotherapy, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 23 May 1995 (29 years ago) |
| Date of dissolution: | 29 Dec 2010 |
| Entity Number: | 000-172-159 |
| Register Number: | 000172159 |
| County: | Madison |
| Place of Formation: | Madison County |
| Principal Address: | HUNTSVILLE, AL |
| Registered Office Street Address: | 3330 L&N DR STE AHUNTSVILLE, AL 35801 |
| Registered Office Street Address ZIP Code: | 35801 |
| Authorized Capital: | $1,500 |
| Paid Share Capital: | ---- |
Activities
PROFESSIONAL COUNSELING/ASSESSMENT & PSYCHOTHERAPY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1053447615 | 2007-02-26 | 2020-08-22 | 3330 L AND N DR SW, SUITE A, HUNTSVILLE, AL, 358015380, US | 3330 L AND N DR SW, SUITE A, HUNTSVILLE, AL, 358015380, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 256-880-7173 |
| Fax | 2568807178 |
Authorized person
| Name | MR. JOHN THOMAS SANDY |
| Role | PARTNER |
| Phone | 2568807173 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | 320 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 103T00000X - Psychologist |
| Is Primary | No |
| Taxonomy Code | 104100000X - Social Worker |
| License Number | 0079C |
| State | AL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | CIGNA |
| Number | 56157 |
| State | AL |
| Issuer | VALUE OPTIONS |
| Number | 103756 |
| State | AL |
| Issuer | UBH |
| Number | 62-78426 |
| State | AL |
| Issuer | BCBS |
| Number | 510-43994SAN |
| State | AL |
| Issuer | AETNA |
| Number | 5306083 |
| State | AL |
| Issuer | REGENCE BLUESHIELD |
| Number | SA1312 |
| State | AL |
| Issuer | VALUE OPTIONS |
| Number | 008478 |
| State | AL |
| Issuer | AETNA |
| Number | 4352583 |
| State | AL |
| Issuer | BC-FEP |
| Number | 51099449 |
| State | AL |
| Issuer | REGENCE BLUESHIELD |
| Number | SA7104 |
| State | AL |
| Issuer | CIGNA |
| Number | 2011841 |
| State | AL |
| Issuer | BCBS |
| Number | 510-43995SAI |
| State | AL |
| Issuer | BCBS-FEP |
| Number | 510-99490 |
| State | AL |
| Issuer | VALUE OPTIONS |
| Number | 088994 |
| State | AL |
| Issuer | UBH |
| Number | 61-69595 |
| State | AL |
| Name | Role |
|---|---|
| TURNBOW, CORNELIA K | Agent |
| Name | Role |
|---|---|
| TURNBOW, CORNELIA K | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
