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General NPI Number Information
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NPI Number | 1447604509
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Entity Type | Organization
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Legal Business Name | MARK SUMMERSON, PHD, LLC
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Dates
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Enumeration Date | 04/14/2016
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Last Update Date | 04/14/2016
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Provider Practice Location Address
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Address Line | 254 E MAIN ST SUITE 226
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City | PULLMAN
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State | WA
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Zip | 99163-2678
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Country | US
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Telephone | 509-330-5456
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Fax | 509-561-6229
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Provider Business Mailing Address
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Address Line | 254 E MAIN ST SUITE 226
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City | PULLMAN
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State | WA
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Zip | 99163-2678
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Country | US
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Telephone | 509-330-5456
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Fax | 509-561-6229
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. MARK SUMMERSON
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Credential | PHD
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Telephone | 509-330-5456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY00002258
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License Number State | WA
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