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NPI Code Detail

MEDICARE: AVERY SUMPTER

MEDICARE: AVERY SUMPTER
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
1390200000XStudent in an Organized Health Care Education/Training Program
2101YP2500XProfessional CounselorC.2405754-TRNEOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225501745
Entity Type Code : Individual
Provider Name (Legal Business Name) : AVERY SUMPTER
Provider Business Mailing Address
First Line : DEPT 781625 PO BOX 78000
Second Line :
City : DETROIT
State : MI
Zip : 48278-1625
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4891 E COUNTY LINE RD
Second Line :
City : MINERAL RIDGE
State : OH
Zip : 44440-9411
Country : US
Telephone Number : 740-564-8768
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2019
Last Update Date : 08/21/2024

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Directions to “ AVERY SUMPTER ” Practice Location

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