Doctor Name: | SUMMER NICOLE BADER |
NPI Number: | 1184907313 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | P1307077 |
Business Practice Address: | 1101 Morgan Street Suite 8 Paragould, AR - 724503949 |
Business Phone Number: | 8703359483 |
Business Fax Number: | 8703359487 |
Mailing Address: | 1815 Pleasant Grove Rd, JONESBORO |
State: | AR |
Postal Code: | 724017870 |
Phone Number: | 8709336886 |
Fax Number: | 8709339395 |
NPI Enumeration Date: | 09/23/2011 |
NPI Last Update Date: | 03/10/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | P1307077 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |