1124464060 NPI number — SUSAN G SUMMERS LCPC, LCAC

Table of content: SUSAN G SUMMERS LCPC, LCAC (NPI 1124464060)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124464060 NPI number — SUSAN G SUMMERS LCPC, LCAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUMMERS
Provider First Name:
SUSAN
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCPC, LCAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124464060
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2400 N WOODLAWN BLVD STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67220-3956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-206-1127
Provider Business Mailing Address Fax Number:
316-206-1137

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NEW PERSPECTIVES LLC
Provider Second Line Business Practice Location Address:
8623 E. 23ND ST NORTH
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-869-2888
Provider Business Practice Location Address Fax Number:
316-425-5550
Provider Enumeration Date:
05/20/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  256 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 2870 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 201121930A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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