Provider Demographics
NPI:1518208552
Name:SUMMERS, MYKISH CHANEL (LSW)
Entity Type:Individual
Prefix:
First Name:MYKISH
Middle Name:CHANEL
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 EDALBERT DRIVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-7695
Mailing Address - Country:US
Mailing Address - Phone:513-741-3100
Mailing Address - Fax:513-741-5686
Practice Address - Street 1:5400 EDALBERT DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-7604
Practice Address - Country:US
Practice Address - Phone:513-741-3100
Practice Address - Fax:513-741-5686
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0901067104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker