Provider Demographics
NPI:1912614785
Name:CLEVENGER, SUMMER (LMHC CTB-2023-0302)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:
Last Name:CLEVENGER
Suffix:
Gender:F
Credentials:LMHC CTB-2023-0302
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3916 AUGUSTA DR SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-8246
Mailing Address - Country:US
Mailing Address - Phone:505-218-6706
Mailing Address - Fax:
Practice Address - Street 1:9016 WASHINGTON ST NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-2728
Practice Address - Country:US
Practice Address - Phone:505-226-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2023-0302101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health