MEDICARE: JACQUE KAY SUMIDA MA, 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	6430	CO

General Provider Information

NPI Number	:	1952641409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUE KAY SUMIDA MA, LPC

Provider Business Mailing Address
First Line	:	8745 W 14TH AVE STE 120
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80215-4850
Country	:	US
Telephone Number	:	303-237-1113
Fax Number	:

Provider Business Practice Location Address
First Line	:	8745 W 14TH AVE STE 120
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80215-4850
Country	:	US
Telephone Number	:	303-237-1113
Fax Number	:

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

Provider Enumeration Date	:	02/20/2013
Last Update Date	:	02/20/2013

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Directions to “ JACQUE KAY SUMIDA MA, LPC” Practice Location

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