Healthcare Provider Details

I. General information

NPI: 1316759608
Provider Name (Legal Business Name): SUMMER LARAY VALENCIA SUDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 E 2100 S
SALT LAKE CITY UT
84115-2237
US

IV. Provider business mailing address

449 E 2100 S
SALT LAKE CITY UT
84115-2237
US

V. Phone/Fax

Practice location:
  • Phone: 877-264-6747
  • Fax: 801-359-3878
Mailing address:
  • Phone: 801-872-4656
  • Fax: 801-359-3878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number14289794-6006
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: