Healthcare Provider Details

I. General information

NPI: 1578545216
Provider Name (Legal Business Name): SHIRLEY SUMMER ALLEN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: SUMMER ALLEN PH.D.

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 WEST BLVD N
COLUMBIA MO
65203-2665
US

IV. Provider business mailing address

3950 E DEER PARK RD
COLUMBIA MO
65201-9716
US

V. Phone/Fax

Practice location:
  • Phone: 573-875-6662
  • Fax:
Mailing address:
  • Phone: 573-443-4168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number01541
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: