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General NPI Number Information
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NPI Number | 1649815614
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Entity Type | Organization
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Legal Business Name | SUMMER COUNSELING AND BEHAVIORAL HEALTH SUMMER COUNSELING
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Dates
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Enumeration Date | 11/13/2019
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Last Update Date | 04/11/2022
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Provider Practice Location Address
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Address Line | 1687 WOODLANE DR STE 208
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City | WOODBURY
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State | MN
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Zip | 55125-3047
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Country | US
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Telephone | 651-327-0849
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Fax |
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Provider Business Mailing Address
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Address Line | 1687 WOODLANE DR STE 208
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City | WOODBURY
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State | MN
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Zip | 55125-3047
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Country | US
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Telephone | 651-327-0849
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JENNIFER SUMMER KOKES
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Credential | MA, LPCC
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Telephone | 651-327-0849
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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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 |
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