Provider Demographics
NPI:1114383221
Name:SMITH, SUMMER DAWN (LPC)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:DAWN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1766 JUNIPER DR
Mailing Address - Street 2:
Mailing Address - City:CHINO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86323-7066
Mailing Address - Country:US
Mailing Address - Phone:228-308-0886
Mailing Address - Fax:
Practice Address - Street 1:3633 CROSSINGS DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7101
Practice Address - Country:US
Practice Address - Phone:877-634-7333
Practice Address - Fax:866-984-3891
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
AZLPC23576101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor