Healthcare Provider Details

I. General information

NPI: 1497490874
Provider Name (Legal Business Name): MELANIE KIM SUMMERS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2022
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date: 07/21/2023
Reactivation Date: 08/09/2023

III. Provider practice location address

12945 W HIGHWAY 42
PROSPECT KY
40059-9107
US

IV. Provider business mailing address

16713 EASTWOOD BLUFF RD
LOUISVILLE KY
40245-4430
US

V. Phone/Fax

Practice location:
  • Phone: 502-709-0410
  • Fax:
Mailing address:
  • Phone: 818-434-8378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number306467
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number285624
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number252308
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: