Provider Demographics
NPI:1427853159
Name:SUMMITT, OLIVIA GRACE (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:GRACE
Last Name:SUMMITT
Suffix:
Gender:
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 W CLOVER DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2720
Mailing Address - Country:US
Mailing Address - Phone:901-647-2989
Mailing Address - Fax:
Practice Address - Street 1:7594 SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-4908
Practice Address - Country:US
Practice Address - Phone:901-610-1722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7751101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health