Doctor Name: | BRENDA SOMMER |
NPI Number: | 1114371150 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC |
License Number: | 180.009098 |
Business Practice Address: | 4 Doctors Park Gibson City, IL - 609362000 |
Business Phone Number: | 2177844540 |
Business Fax Number: | |
Mailing Address: | 4 Doctors Park, GIBSON CITY |
State: | IL |
Postal Code: | 609362000 |
Phone Number: | 2177844540 |
Fax Number: | |
NPI Enumeration Date: | 04/15/2016 |
NPI Last Update Date: | 04/15/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 180.009098 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |