Provider Demographics
NPI:1750581674
Name:SUMMERS, AUDREY GREENE (MS MFT)
Entity type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:GREENE
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:MS MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595
Mailing Address - Country:US
Mailing Address - Phone:951-378-6080
Mailing Address - Fax:951-471-2380
Practice Address - Street 1:41690 ENTERPRISE CIRCLE NO
Practice Address - Street 2:STE 106
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590
Practice Address - Country:US
Practice Address - Phone:951-378-6080
Practice Address - Fax:951-471-2380
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44683106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist