Provider Demographics
NPI:1700178712
Name:SUMNER, LATICIA M (LIMHP, LPC)
Entity Type:Individual
Prefix:MRS
First Name:LATICIA
Middle Name:M
Last Name:SUMNER
Suffix:
Gender:F
Credentials:LIMHP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 LAKERIDGE DR STE 104B
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-2558
Mailing Address - Country:US
Mailing Address - Phone:402-640-5569
Mailing Address - Fax:402-844-3406
Practice Address - Street 1:2501 LAKERIDGE DR STE 104B
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-2558
Practice Address - Country:US
Practice Address - Phone:402-649-0617
Practice Address - Fax:402-844-3406
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE758101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health