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General NPI Number Information
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NPI Number | 1750581674
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Entity Type | Individual
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Provider Name | AUDREY GREENE SUMMERS MS MFT
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Gender | Female
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 08/06/2007
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Provider Practice Location Address
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Address Line | 41690 ENTERPRISE CIRCLE NO STE 106
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City | TEMECULA
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State | CA
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Zip | 92590
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Country | US
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Telephone | 951-378-6080
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Fax | 951-471-2380
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Provider Business Mailing Address
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Address Line | PO BOX 26
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City | WILDOMAR
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State | CA
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Zip | 92595
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Country | US
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Telephone | 951-378-6080
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Fax | 951-471-2380
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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 | MFC44683
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License Number State | CA
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