Provider Demographics
NPI:1396181343
Name:SUMMERS, AMANDA MAY KLEEMAN (LPC-S, LPCC, NCC, MS)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MAY KLEEMAN
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:LPC-S, LPCC, NCC, MS
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:SUMMERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AMANDA MAY KLEEMAN
Mailing Address - Street 1:15 W 6TH ST STE 1211
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74119-5406
Mailing Address - Country:US
Mailing Address - Phone:918-299-5055
Mailing Address - Fax:918-295-5056
Practice Address - Street 1:419 GEORGIA ST STE 11
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-6046
Practice Address - Country:US
Practice Address - Phone:707-688-8859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-17
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OK7328101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200531320BMedicaid