Provider Demographics
NPI:1386437457
Name:SUMMERS, PATTI JOLEEN (LPC)
Entity type:Individual
Prefix:
First Name:PATTI
Middle Name:JOLEEN
Last Name:SUMMERS
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 1:125 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-2235
Mailing Address - Country:US
Mailing Address - Phone:208-339-4356
Mailing Address - Fax:
Practice Address - Street 1:490 PARK AVE STE 4
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-1230
Practice Address - Country:US
Practice Address - Phone:208-339-4356
Practice Address - Fax:208-612-5035
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-22
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCOUI-10191101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health