Healthcare Provider Details

I. General information

NPI: 1396181343
Provider Name (Legal Business Name): AMANDA MAY KLEEMAN SUMMERS LPC-S, LPCC, NCC, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA SUMMERS AMANDA MAY KLEEMAN

II. Dates (important events)

Enumeration Date: 05/17/2013
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 GEORGIA ST STE 11
VALLEJO CA
94590-6046
US

IV. Provider business mailing address

15 W 6TH ST STE 1211
TULSA OK
74119-5406
US

V. Phone/Fax

Practice location:
  • Phone: 707-688-8859
  • Fax:
Mailing address:
  • Phone: 918-299-5055
  • Fax: 918-295-5056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7328
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: