MEDICARE: SUMMER KEETCH CSW

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	101YM0800X	Mental Health Counselor	14290580-3502	UT

General Provider Information

NPI Number	:	1407686181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUMMER KEETCH CSW

Provider Business Mailing Address
First Line	:	750 N FREEDOM BLVD
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84601-1677
Country	:	US
Telephone Number	:	801-373-4760
Fax Number	:

Provider Business Practice Location Address
First Line	:	954 N 200 E
Second Line	:
City	:	SPANISH FORK
State	:	UT
Zip	:	84660-1247
Country	:	US
Telephone Number	:	801-901-3330
Fax Number	:

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

Provider Enumeration Date	:	08/06/2024
Last Update Date	:	06/04/2026

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Directions to “ SUMMER KEETCH CSW” Practice Location

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