Healthcare Provider Details

I. General information

NPI: 1235267022
Provider Name (Legal Business Name): LINDA K SUMMERS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 INDIAN SCHOOL RD NE STE 200E
ALBUQUERQUE NM
87112-2861
US

IV. Provider business mailing address

8205 SPAIN RD NE STE 106
ALBUQUERQUE NM
87109-3155
US

V. Phone/Fax

Practice location:
  • Phone: 505-306-2307
  • Fax: 505-260-9934
Mailing address:
  • Phone: 505-306-2307
  • Fax: 505-260-9934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0087141
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: