Provider Demographics
NPI:1689081150
Name:SUM, MICHELLE MERTENS (MS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MERTENS
Last Name:SUM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 LAUREL HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-3105
Mailing Address - Country:US
Mailing Address - Phone:916-320-5384
Mailing Address - Fax:
Practice Address - Street 1:7000 FRANKLIN BLVD STE 625
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-1884
Practice Address - Country:US
Practice Address - Phone:916-203-6513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)