MEDICARE: MARY E SUMMERS BS/BHRS

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	225C00000X	Rehabilitation Counselor	BHRS CERTIFICATION	OK
2	101YP2500X	Professional Counselor	6100	OK

Other Identifiers

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

General Provider Information

NPI Number	:	1841623444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY E SUMMERS BS/BHRS

Provider Business Mailing Address
First Line	:	3705 W DETROIT ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-2183
Country	:	US
Telephone Number	:	918-361-4664
Fax Number	:	800-260-7966

Provider Business Practice Location Address
First Line	:	4122 W 55TH PLACE S.
Second Line	:	SUITE 119
City	:	TULSA
State	:	OK
Zip	:	74107-9108
Country	:	US
Telephone Number	:	918-486-9996
Fax Number	:	800-260-7966

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

Provider Enumeration Date	:	08/19/2013
Last Update Date	:	03/04/2021

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