Provider Demographics
NPI:1275709032
Name:SUMMER GROVE COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:SUMMER GROVE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER AND SOLE MEMBER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUFF
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:318-469-0146
Mailing Address - Street 1:9300 MANSFIELD RD STE 107
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3137
Mailing Address - Country:US
Mailing Address - Phone:318-469-0146
Mailing Address - Fax:318-687-0261
Practice Address - Street 1:9300 MANSFIELD RD STE 107
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3137
Practice Address - Country:US
Practice Address - Phone:318-469-0146
Practice Address - Fax:318-687-0261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALPC 2593251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health