Provider Demographics
NPI:1861239444
Name:MIKKELSEN, SUMMER LYN (LMSW)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:LYN
Last Name:MIKKELSEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 MCNEIL DR APT 321
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-7941
Mailing Address - Country:US
Mailing Address - Phone:801-867-1699
Mailing Address - Fax:
Practice Address - Street 1:6800 MCNEIL DR APT 321
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729-7941
Practice Address - Country:US
Practice Address - Phone:801-867-1699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113573104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker