Healthcare Provider Details

I. General information

NPI: 1871085183
Provider Name (Legal Business Name): ERIC SUMMERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2068 S EAGLE RD
MERIDIAN ID
83642-6707
US

IV. Provider business mailing address

835 E WANDERING LN APT 103
KUNA ID
83634-5476
US

V. Phone/Fax

Practice location:
  • Phone: 208-340-1688
  • Fax: 208-887-3660
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8331637
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: