Provider Demographics
NPI:1871824649
Name:SUMMERS, DESIREE (LPCC-S)
Entity Type:Individual
Prefix:MS
First Name:DESIREE
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 S COURT ST STE 500
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-4354
Mailing Address - Country:US
Mailing Address - Phone:216-396-0629
Mailing Address - Fax:330-319-6111
Practice Address - Street 1:1075 S COURT ST STE 500
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-4354
Practice Address - Country:US
Practice Address - Phone:216-396-0629
Practice Address - Fax:330-319-6111
Is Sole Proprietor?:No
Enumeration Date:2010-01-19
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OHE.0900411-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE.0900411-SUPVOtherLPCC-S
OH0253004Medicaid