Provider Demographics
NPI:1174665210
Name:SUMMERS, MARK A (LMFT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 GREEN RIVER RD # 105-151
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-7433
Mailing Address - Country:US
Mailing Address - Phone:951-777-9798
Mailing Address - Fax:
Practice Address - Street 1:4181 FLAT ROCK DR STE 302
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-7106
Practice Address - Country:US
Practice Address - Phone:909-777-9798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CALMFT106989106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health