Provider Demographics
NPI:1679285365
Name:SUMMERLANE COUNSELING LLC
Entity Type:Organization
Organization Name:SUMMERLANE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEMENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC-S, NCC, MA
Authorized Official - Phone:334-413-2235
Mailing Address - Street 1:4171 LOMAC ST.
Mailing Address - Street 2:STE F #1127
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2945
Mailing Address - Country:US
Mailing Address - Phone:334-413-2235
Mailing Address - Fax:
Practice Address - Street 1:964 EXCELSIOR DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-4514
Practice Address - Country:US
Practice Address - Phone:334-413-2235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-14
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty