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General NPI Number Information
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NPI Number | 1548983836
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Entity Type | Organization
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Legal Business Name | EK PSYCH - EMOTIVE KNOWLEDGE PSYCHOLOGY A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/21/2022
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Last Update Date | 09/21/2022
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Provider Practice Location Address
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Address Line | 1441 SUPERIOR AVE STE F
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-2704
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Country | US
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Telephone | 714-494-1867
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Fax |
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Provider Business Mailing Address
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Address Line | 1707 MORNING CANYON RD
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City | DIAMOND BAR
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State | CA
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Zip | 91765-2826
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Country | US
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Telephone | 714-494-1867
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. MICHAEL W SUMMERLIN
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Credential | PH.D
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Telephone | 714-494-1867
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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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