Provider Demographics
NPI:1619247640
Name:PACKWOOD, SUMMER (LSW)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:
Last Name:PACKWOOD
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 1:517 OLD CREEK LN
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-8573
Mailing Address - Country:US
Mailing Address - Phone:502-744-4793
Mailing Address - Fax:
Practice Address - Street 1:517 OLD CREEK LN
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-8573
Practice Address - Country:US
Practice Address - Phone:502-744-4793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN102687002101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health