Healthcare Provider Details

I. General information

NPI: 1093670804
Provider Name (Legal Business Name): SUMMER TIA EGLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29970 TECHNOLOGY DR STE 212
MURRIETA CA
92563-2649
US

IV. Provider business mailing address

39261 DELHAVEN ST APT 4309
MURRIETA CA
92563-9712
US

V. Phone/Fax

Practice location:
  • Phone: 951-900-4414
  • Fax:
Mailing address:
  • Phone: 951-303-5402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: