Healthcare Provider Details

I. General information

NPI: 1407786080
Provider Name (Legal Business Name): SUMMER IJARAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W NASA PKWY STE E
WEBSTER TX
77598-1648
US

IV. Provider business mailing address

1400 W NASA PKWY STE E
WEBSTER TX
77598-1648
US

V. Phone/Fax

Practice location:
  • Phone: 281-993-8040
  • Fax: 281-816-5526
Mailing address:
  • Phone: 281-993-8040
  • Fax: 281-816-5526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number41199
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: