MEDICARE: ERIC SUMMERS

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	106S00000X	Behavior Technician
2	101YM0800X	Mental Health Counselor	8331637	ID

General Provider Information

NPI Number	:	1871085183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC SUMMERS

Provider Business Mailing Address
First Line	:	835 E WANDERING LN APT 103
Second Line	:
City	:	KUNA
State	:	ID
Zip	:	83634-5476
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2068 S EAGLE RD
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-6707
Country	:	US
Telephone Number	:	208-340-1688
Fax Number	:	208-887-3660

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

Provider Enumeration Date	:	06/01/2018
Last Update Date	:	06/02/2026

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Directions to “ ERIC SUMMERS ” Practice Location

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