Provider Demographics
NPI:1396032066
Name:SUMMIT, MIRANDA F (MED)
Entity Type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:F
Last Name:SUMMIT
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MS
Other - First Name:MIRANDA
Other - Middle Name:F
Other - Last Name:VINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:1646 N 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-3527
Mailing Address - Country:US
Mailing Address - Phone:580-565-2175
Mailing Address - Fax:
Practice Address - Street 1:127 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-4700
Practice Address - Country:US
Practice Address - Phone:580-931-3008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health