Healthcare Provider Details

I. General information

NPI: 1972010890
Provider Name (Legal Business Name): ASHLEY FRANCES SUMMERS MLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2017
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 KENMOOR AVE SE STE 215
GRAND RAPIDS MI
49546-2395
US

IV. Provider business mailing address

1887 HORIZON DR
IONIA MI
48846-2029
US

V. Phone/Fax

Practice location:
  • Phone: 616-805-3660
  • Fax: 616-805-3631
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301017271
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361006534
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: