Healthcare Provider Details

I. General information

NPI: 1336290022
Provider Name (Legal Business Name): RONALD RAYMOND SUMMERHILL PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 01/27/2024
Certification Date: 01/27/2024
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 Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3809
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number3809
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3809
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number3987
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number3987
License Number StateTN
# 6
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3987
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: