Provider Demographics
NPI:1235381930
Name:BROWN, SUMMER L (MS)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 NE 77TH AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6829
Mailing Address - Country:US
Mailing Address - Phone:360-602-1477
Mailing Address - Fax:360-334-5508
Practice Address - Street 1:4400 NE 77TH AVE STE 215
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6829
Practice Address - Country:US
Practice Address - Phone:360-602-1477
Practice Address - Fax:360-334-5508
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT49991106H00000X
WALF60233689106H00000X
ORT1497106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2043289Medicaid