MEDICARE: TAD SUMNER LCSW, CDCI

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	1041C0700X	Clinical Social Worker	1042	AK

General Provider Information

NPI Number	:	1932439452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAD SUMNER LCSW, CDCI

Provider Business Mailing Address
First Line	:	701 E TUDOR RD
Second Line	:	STE 135
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-7457
Country	:	US
Telephone Number	:	907-644-8044
Fax Number	:	907-644-8004

Provider Business Practice Location Address
First Line	:	701 E TUDOR RD
Second Line	:	STE 135
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-7457
Country	:	US
Telephone Number	:	907-644-8044
Fax Number	:	907-644-8004

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

Provider Enumeration Date	:	01/05/2010
Last Update Date	:	02/01/2012

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