Provider Demographics
NPI:1891203758
Name:SANDERS, SUMMER (LMFT, PPSC, PASC)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LMFT, PPSC, PASC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1637 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-1929
Mailing Address - Country:US
Mailing Address - Phone:562-395-4456
Mailing Address - Fax:
Practice Address - Street 1:1637 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-1929
Practice Address - Country:US
Practice Address - Phone:562-395-4456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-12
Last Update Date:2019-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT78181101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty