Provider Demographics
NPI:1821167644
Name:SUMMERS, BRENDA (LPC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3346 125TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-9275
Mailing Address - Country:US
Mailing Address - Phone:269-598-3231
Mailing Address - Fax:269-686-2011
Practice Address - Street 1:217 HUBBARD ST
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-1320
Practice Address - Country:US
Practice Address - Phone:269-673-1896
Practice Address - Fax:269-686-2011
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3397-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional