Provider Demographics
NPI:1518392489
Name:SUMNER, MIRANDA ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:ANN
Last Name:SUMNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4531 HWY 54 STE 1
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-2486
Mailing Address - Country:US
Mailing Address - Phone:270-240-4425
Mailing Address - Fax:270-228-4252
Practice Address - Street 1:4531 HWY 54 STE 1
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-2486
Practice Address - Country:US
Practice Address - Phone:270-765-2605
Practice Address - Fax:270-240-4425
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
KY2526961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker