Provider Demographics
NPI:1093241531
Name:SUMMERS, MICHELLE G (LPC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:G
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7318 W MAGIC MOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-3481
Mailing Address - Country:US
Mailing Address - Phone:512-694-6233
Mailing Address - Fax:
Practice Address - Street 1:7318 W MAGIC MOUNTAIN LN
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-3481
Practice Address - Country:US
Practice Address - Phone:512-694-6233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72654101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional