Provider Demographics
NPI:1538791249
Name:SUMMERS, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
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 1:9196 W BARNES DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1552
Mailing Address - Country:US
Mailing Address - Phone:208-433-0400
Mailing Address - Fax:208-433-5271
Practice Address - Street 1:9196 W BARNES DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1552
Practice Address - Country:US
Practice Address - Phone:208-433-0400
Practice Address - Fax:208-433-5271
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1258101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor