Provider Demographics
NPI:1912123308
Name:SUMO, DAVID KENNETH III
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:KENNETH
Last Name:SUMO
Suffix:III
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:KENNETH
Other - Last Name:SUMO
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:MS LPC U/S
Mailing Address - Street 1:1900 NE 36TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-5218
Mailing Address - Country:US
Mailing Address - Phone:405-466-3851
Mailing Address - Fax:405-466-3851
Practice Address - Street 1:522 SW BRUCE ST.
Practice Address - Street 2:
Practice Address - City:LANGSTON
Practice Address - State:OK
Practice Address - Zip Code:73055
Practice Address - Country:US
Practice Address - Phone:405-466-3851
Practice Address - Fax:405-466-3851
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program