Basic Information
Provider Information
NPI: 1518087519
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SOMMERS
FirstName: MICHAEL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LPCC-S, LSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5399 LAUBY RD.
Address2:  
City: NORTH CANTON
State: OH
PostalCode: 44720
CountryCode: US
TelephoneNumber: 3304977726
FaxNumber:  
Practice Location
Address1: 2803 AKRON RD
Address2:  
City: WOOSTER
State: OH
PostalCode: 446917904
CountryCode: US
TelephoneNumber: 3302643232
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/31/2007
LastUpdateDate: 11/04/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101Y00000X  N Behavioral Health & Social Service ProvidersCounselor 
104100000XS0022101OHN Behavioral Health & Social Service ProvidersSocial Worker 
101Y00000XC0600130OHY Behavioral Health & Social Service ProvidersCounselor 

No ID Information.


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