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General NPI Number Information
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NPI Number | 1275932063
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Entity Type | Individual
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Provider Name | JENNIFER SUMMERS PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 08/18/2014
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Last Update Date | 12/23/2019
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Provider Practice Location Address
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Address Line | 113 VILLAGE CIR
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City | PISMO BEACH
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State | CA
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Zip | 93449-3421
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Country | US
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Telephone | 805-275-3262
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Fax |
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Provider Business Mailing Address
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Address Line | 4929 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90010-3808
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Country | US
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Telephone | 800-992-8800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 31383
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License Number State | CA
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