Provider Demographics
NPI:1326581588
Name:LINDA SUMMERS ADULT & CHILD PSYCHOTHERAPY
Entity Type:Organization
Organization Name:LINDA SUMMERS ADULT & CHILD PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC MA
Authorized Official - Phone:505-377-0558
Mailing Address - Street 1:PO BOX 3172
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87190-3172
Mailing Address - Country:US
Mailing Address - Phone:505-377-0558
Mailing Address - Fax:
Practice Address - Street 1:1424 DEBORAH RD SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1058
Practice Address - Country:US
Practice Address - Phone:505-377-0558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM03-241129-00-4101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00026778Medicaid