Provider Demographics
NPI:1043495708
Name:OLSEN, SUMMER D (LCP, LCAC)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:D
Last Name:OLSEN
Suffix:
Gender:F
Credentials:LCP, LCAC
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:D
Other - Last Name:RHOADS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 S SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-4144
Mailing Address - Country:US
Mailing Address - Phone:785-452-7706
Mailing Address - Fax:785-452-7279
Practice Address - Street 1:730 HOLLY LN
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401
Practice Address - Country:US
Practice Address - Phone:785-452-4930
Practice Address - Fax:785-452-4932
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200550710AMedicaid