Healthcare Provider Details

I. General information

NPI: 1487054953
Provider Name (Legal Business Name): SUMMER WYERS MS, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 01/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2907 W 108TH PL S
JENKS OK
74037-2481
US

IV. Provider business mailing address

2907 W 108TH PL S
JENKS OK
74037-2481
US

V. Phone/Fax

Practice location:
  • Phone: 918-212-4091
  • Fax:
Mailing address:
  • Phone: 918-212-4091
  • Fax: 918-960-9551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6295
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: