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General NPI Number Information
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NPI Number | 1770243057
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Entity Type | Individual
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Provider Name | ALEXIS RENEE SUMNER LPC
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Gender | Female
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Dates
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Enumeration Date | 12/28/2021
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Last Update Date | 06/11/2024
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Provider Practice Location Address
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Address Line | 15146 16TH AVE
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City | MARNE
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State | MI
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Zip | 49435-9605
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Country | US
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Telephone | 616-520-9074
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Fax |
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Provider Business Mailing Address
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Address Line | 159 OLMSTEAD ST
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City | SPARTA
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State | MI
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Zip | 49345-1123
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Country | US
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Telephone | 616-690-0006
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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 | 6401224296
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License Number State | MI
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