Provider Demographics
NPI:1497417703
Name:SUMMERS, CAMIRA
Entity Type:Individual
Prefix:
First Name:CAMIRA
Middle Name:
Last Name:SUMMERS
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 1:201 E ELDORADO PKWY APT 1428
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-5396
Mailing Address - Country:US
Mailing Address - Phone:214-538-7892
Mailing Address - Fax:
Practice Address - Street 1:201 E ELDORADO PKWY APT 1428
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-5396
Practice Address - Country:US
Practice Address - Phone:214-538-7892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X101YP1600X
172A00000X, 101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No172A00000XOther Service ProvidersDriverGroup - Single Specialty