Provider Demographics
NPI:1083030969
Name:JOHNSON, SUMMER LYNN
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:LYNN
Other - Last Name:WOOLSEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LAMFT
Mailing Address - Street 1:463 CIMARRON AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-6535
Mailing Address - Country:US
Mailing Address - Phone:801-793-0388
Mailing Address - Fax:
Practice Address - Street 1:463 CIMARRON AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-6535
Practice Address - Country:US
Practice Address - Phone:801-793-0388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-15
Last Update Date:2014-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8777194-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist