Provider Demographics
NPI:1477018026
Name:GAYNOR, SUMMER LYNAYA (LMFT)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:LYNAYA
Last Name:GAYNOR
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:LYNAYA
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:311 S VENTU PARK RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-4645
Mailing Address - Country:US
Mailing Address - Phone:805-390-7110
Mailing Address - Fax:
Practice Address - Street 1:150 S BARRINGTON AVE STE 9
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-3315
Practice Address - Country:US
Practice Address - Phone:805-390-7110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111521106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist