MEDICARE: MS. SUMMER SUNSHINE MARTINEZ LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	LPCC.0016906	CO

General Provider Information

NPI Number	:	1134738321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUMMER SUNSHINE MARTINEZ LPCC

Provider Business Mailing Address
First Line	:	174 LARISSA LN
Second Line	:
City	:	BUENA VISTA
State	:	CO
Zip	:	81211-9188
Country	:	US
Telephone Number	:	719-207-2492
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 E MAIN ST # 205
Second Line	:
City	:	BUENA VISTA
State	:	CO
Zip	:	81211-5011
Country	:	US
Telephone Number	:	719-496-8841
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2020
Last Update Date	:	07/24/2020

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