Provider Demographics
NPI:1164542270
Name:STEPHANIE SUMMERS LMFT, P.A.
Entity Type:Organization
Organization Name:STEPHANIE SUMMERS LMFT, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:904-268-9178
Mailing Address - Street 1:12412 SAN JOSE BLVD
Mailing Address - Street 2:SUITE 102C
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-8621
Mailing Address - Country:US
Mailing Address - Phone:904-268-9178
Mailing Address - Fax:
Practice Address - Street 1:12412 SAN JOSE BLVD
Practice Address - Street 2:SUITE 102C
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8621
Practice Address - Country:US
Practice Address - Phone:904-268-9178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2128106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMT2128OtherPROFESSIONAL LICENSE NUMB