Healthcare Provider Details

I. General information

NPI: 1124380977
Provider Name (Legal Business Name): AMANDA L SUMMERS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 CROSSROADS BLVD.
NORMAN OK
73072
US

IV. Provider business mailing address

911 DAHLIA LANE
NOBLE OK
73068
US

V. Phone/Fax

Practice location:
  • Phone: 405-361-4524
  • Fax: 405-701-8531
Mailing address:
  • Phone: 405-361-4524
  • Fax: 405-701-8531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5194
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: