Healthcare Provider Details

I. General information

NPI: 1740198266
Provider Name (Legal Business Name): JILLIAN BROOKE SUMMAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 LONGVIEW ST STE 307
AUSTIN TX
78705-4202
US

IV. Provider business mailing address

7202 SIR GAWAIN DR
AUSTIN TX
78745-5568
US

V. Phone/Fax

Practice location:
  • Phone: 512-607-9360
  • Fax:
Mailing address:
  • Phone: 918-520-1078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number103672
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: