Healthcare Provider Details

I. General information

NPI: 1376986620
Provider Name (Legal Business Name): PAULA A SUMMAR LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 ALTO ST
SANTA FE NM
87501-2406
US

IV. Provider business mailing address

1035 ALTO ST
SANTA FE NM
87501-2406
US

V. Phone/Fax

Practice location:
  • Phone: 505-955-0329
  • Fax: 505-982-8440
Mailing address:
  • Phone: 505-955-0329
  • Fax: 505-982-8440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT0157131
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: