Provider Demographics
NPI:1124380977
Name:SUMMERS, AMANDA L (LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
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 1:911 DAHLIA LANE
Mailing Address - Street 2:
Mailing Address - City:NOBLE
Mailing Address - State:OK
Mailing Address - Zip Code:73068
Mailing Address - Country:US
Mailing Address - Phone:405-361-4524
Mailing Address - Fax:405-701-8531
Practice Address - Street 1:1215 CROSSROADS BLVD.
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072
Practice Address - Country:US
Practice Address - Phone:405-361-4524
Practice Address - Fax:405-701-8531
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5194101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200432940AMedicaid