Healthcare Provider Details

I. General information

NPI: 1538117080
Provider Name (Legal Business Name): SCOTT W SUMERALL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 S 4TH ST L-116-ATP
LEAVENWORTH KS
66048-5014
US

IV. Provider business mailing address

106 BETSY CT
SMITHVILLE MO
64089-8366
US

V. Phone/Fax

Practice location:
  • Phone: 913-682-2000
  • Fax:
Mailing address:
  • Phone: 816-532-3332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberR0378
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number253
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: