Basic Information
| Provider Information | |||||||||
| NPI: | 1306205349 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUMMERS | ||||||||
| FirstName: | AMY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3108 ARBORSHADE TRACE | ||||||||
| Address2: | |||||||||
| City: | OWENS CROSS ROADS | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567833700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4092 MEMORIAL PKWY SW | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358024365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568822457 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2016 | ||||||||
| LastUpdateDate: | 02/18/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-15-21129 | AL | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.