Healthcare Provider Details

I. General information

NPI: 1841623444
Provider Name (Legal Business Name): MARY E SUMMERS BS/BHRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4122 W 55TH PLACE S. SUITE 119
TULSA OK
74107-9108
US

IV. Provider business mailing address

3705 W DETROIT ST
BROKEN ARROW OK
74012-2183
US

V. Phone/Fax

Practice location:
  • Phone: 918-486-9996
  • Fax: 800-260-7966
Mailing address:
  • Phone: 918-361-4664
  • Fax: 800-260-7966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License NumberBHRS CERTIFICATION
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6100
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: