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General NPI Number Information
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NPI Number | 1104342880
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Entity Type | Individual
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Provider Name | BLANCHE NICOLE SUMNER MS, LCPC
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Gender | Female
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Dates
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Enumeration Date | 08/15/2017
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 198 S. SKILL CENTER ROAD
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City | SACATON
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State | AZ
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Zip | 85147
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Country | US
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Telephone | 480-698-1259
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Fax |
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Provider Business Mailing Address
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Address Line | 17805 S 543 RD
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City | TAHLEQUAH
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State | OK
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Zip | 74464-2001
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Country | US
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Telephone | 918-457-0084
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 55464
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License Number State | MT
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