Provider Demographics
NPI:1902605850
Name:SEARS, SUMMER BETH
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:BETH
Last Name:SEARS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 S 600 W
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-8712
Mailing Address - Country:US
Mailing Address - Phone:765-461-6915
Mailing Address - Fax:
Practice Address - Street 1:719 SPENCER ST
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-3583
Practice Address - Country:US
Practice Address - Phone:765-461-6915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-25-418481106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician