Healthcare Provider Details

I. General information

NPI: 1598906323
Provider Name (Legal Business Name): SUMMER T ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 03/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SILVER ST
KINGMAN AZ
86401-5545
US

IV. Provider business mailing address

537 6TH ST STE C
PRESCOTT AZ
86301-2021
US

V. Phone/Fax

Practice location:
  • Phone: 928-530-4698
  • Fax:
Mailing address:
  • Phone: 928-777-3280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: