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General NPI Number Information
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NPI Number | 1952972473
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Entity Type | Individual
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Provider Name | CARMEL YVETTE SUMMERVILLE
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Gender | Female
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Dates
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Enumeration Date | 07/06/2021
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Last Update Date | 07/06/2021
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Provider Practice Location Address
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Address Line | 965 BURTON RAY ST NE
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City | LACEY
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State | WA
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Zip | 98516-7603
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Country | US
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Telephone | 360-605-0163
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Fax |
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Provider Business Mailing Address
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Address Line | 5918 56TH AVE W APT D13
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98467-3500
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Country | US
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Telephone | 253-223-8829
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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