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General NPI Number Information
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NPI Number | 1154474278
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Entity Type | Individual
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Provider Name | SUMMER LESLIE EGGLESTON M.F.T., C.S.A.C.
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Gender | Female
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 10/09/2023
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Provider Practice Location Address
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Address Line | 75-127 LUNAPULE RD STE 15B
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City | KAILUA KONA
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State | HI
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Zip | 96740-2119
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Country | US
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Telephone | 808-327-1711
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Fax |
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Provider Business Mailing Address
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Address Line | 75-402 HOENE ST
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City | KAILUA KONA
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State | HI
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Zip | 96740-1965
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Country | US
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Telephone | 808-756-2829
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | #59
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License Number State | HI
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