Basic Information
| Provider Information | |||||||||
| NPI: | 1144211269 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUMMERS | ||||||||
| FirstName: | DONALD | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 525 E 15TH ST | ||||||||
| Address2: | |||||||||
| City: | PANAMA CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324055412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8505224485 | ||||||||
| FaxNumber: | 8509146281 | ||||||||
| Practice Location | |||||||||
| Address1: | 311 WILLIAMS AVE | ||||||||
| Address2: | |||||||||
| City: | PORT ST JOE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324561845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8502271145 | ||||||||
| FaxNumber: | 8509148261 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MH6008 | FL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.