Provider Demographics
NPI:1164569018
Name:SUMPOLEC, JEFFREY (MA LPC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:SUMPOLEC
Suffix:
Gender:M
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18565 SOLEDAD CANYON RD STE 302
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-3700
Mailing Address - Country:US
Mailing Address - Phone:540-842-4999
Mailing Address - Fax:
Practice Address - Street 1:18333 DOLAN WAY STE 205
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91387-5423
Practice Address - Country:US
Practice Address - Phone:540-842-4999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
VA0701003590101YP2500X
CALPCC9308101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional