Provider Demographics
NPI:1023648706
Name:ALLEN, SUMMER BREEZE (PHD, LPC)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:BREEZE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 FORTVIEW RD STE 112D
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7656
Mailing Address - Country:US
Mailing Address - Phone:512-222-3362
Mailing Address - Fax:
Practice Address - Street 1:1825 FORTVIEW RD STE 112G
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7658
Practice Address - Country:US
Practice Address - Phone:512-222-3362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73721101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty