Provider Demographics
NPI:1417387721
Name:SUMMERS, HEATHER LEIGH
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEIGH
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13280 NW HOECAKE RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:FL
Mailing Address - Zip Code:32321-3426
Mailing Address - Country:US
Mailing Address - Phone:850-447-5256
Mailing Address - Fax:
Practice Address - Street 1:13280 NW HOECAKE RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:FL
Practice Address - Zip Code:32321-3426
Practice Address - Country:US
Practice Address - Phone:850-447-5256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-22
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11917101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health