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General NPI Number Information
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NPI Number | 1790500999
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Entity Type | Individual
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Provider Name | KATHY LYNNE SUMMERS LCDC-I
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Gender | Female
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 2425 TEXAS DR
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City | IRVING
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State | TX
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Zip | 75062-7027
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Country | US
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Telephone | 945-288-0030
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Fax |
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Provider Business Mailing Address
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Address Line | 9121 WINDRUSH DR N APT 1008
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City | FORT WORTH
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State | TX
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Zip | 76116-6653
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Country | US
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Telephone | 817-209-9601
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 66673
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License Number State | TX
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