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General NPI Number Information
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NPI Number | 1285273706
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Entity Type | Organization
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Legal Business Name | SUMMIT PSYCHOLOGICAL SERVICES, A PROFESSIONAL PSYCH
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Dates
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Enumeration Date | 01/01/2020
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 222 N MOUNTAIN AVE STE 110B
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City | UPLAND
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State | CA
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Zip | 91786-5714
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Country | US
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Telephone | 909-999-5220
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Fax | 909-781-2422
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Provider Business Mailing Address
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Address Line | 222 N MOUNTAIN AVE STE 110B
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City | UPLAND
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State | CA
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Zip | 91786-5714
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Country | US
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Telephone | 909-999-5220
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | STEPHANIE JOHNSON
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Credential |
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Telephone | 714-264-4909
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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 |
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License Number State |
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