Provider Demographics
NPI:1437625431
Name:SOMMERS, CASEY RUTHERFORD
Entity Type:Individual
Prefix:MS
First Name:CASEY
Middle Name:RUTHERFORD
Last Name:SOMMERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10425 PLAZA AMERICANA DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-8188
Mailing Address - Country:US
Mailing Address - Phone:225-810-4719
Mailing Address - Fax:
Practice Address - Street 1:10425 PLAZA AMERICANA DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-8188
Practice Address - Country:US
Practice Address - Phone:225-810-4719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4359101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health