Provider Demographics
NPI:1558000133
Name:SUMMERS, JOHN (MS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 NW DOGWOOD ST STE B
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-3258
Mailing Address - Country:US
Mailing Address - Phone:425-269-3277
Mailing Address - Fax:
Practice Address - Street 1:75 NW DOGWOOD ST STE B
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3258
Practice Address - Country:US
Practice Address - Phone:425-269-3277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61268683101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health