MEDICARE: MS. LINDA K SUMMERS LPC

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	101YP2500X	Professional Counselor	0087141	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	251S00000X CBH	OTHER	NM	AGENCY

General Provider Information

NPI Number	:	1235267022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDA K SUMMERS LPC

Provider Business Mailing Address
First Line	:	8205 SPAIN RD NE STE 106
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-3155
Country	:	US
Telephone Number	:	505-306-2307
Fax Number	:	505-260-9934

Provider Business Practice Location Address
First Line	:	9301 INDIAN SCHOOL RD NE STE 200E
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-2861
Country	:	US
Telephone Number	:	505-306-2307
Fax Number	:	505-260-9934

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

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	07/18/2012

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