Healthcare Provider Details

I. General information

NPI: 1376848416
Provider Name (Legal Business Name): RONALD R SUMMERHILL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2011
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3066 BERNA WAY
MORRISTOWN TN
37814-5640
US

IV. Provider business mailing address

3066 BERNA WAY
MORRISTOWN TN
37814-5640
US

V. Phone/Fax

Practice location:
  • Phone: 480-580-3234
  • Fax:
Mailing address:
  • Phone: 480-580-3234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1111
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3809
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number3809
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number3809
License Number StateAZ
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3809
License Number StateAZ

VIII. Authorized Official

Name: DR. RONALD RAYMOND SUMMERHILL
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 480-580-3234