Healthcare Provider Details

I. General information

NPI: 1073859963
Provider Name (Legal Business Name): JERRY ALAN SUMMERFIELD LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2012
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N SHORE DR STE 202
JEFFERSONVILLE IN
47130-3145
US

IV. Provider business mailing address

245 CHERRY ST APT A
NEW ALBANY IN
47150-4806
US

V. Phone/Fax

Practice location:
  • Phone: 812-913-7200
  • Fax:
Mailing address:
  • Phone: 812-913-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH13868
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39003597A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: