Provider Demographics
NPI:1720201981
Name:SUMBER, JEFFREY (MA, MTS, LCPC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:SUMBER
Suffix:
Gender:M
Credentials:MA, MTS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 W ARDMORE AVE
Mailing Address - Street 2:#1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3466
Mailing Address - Country:US
Mailing Address - Phone:312-636-7699
Mailing Address - Fax:
Practice Address - Street 1:5138 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2828
Practice Address - Country:US
Practice Address - Phone:312-636-7699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0001636336101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health