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General NPI Number Information
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NPI Number | 1609320902
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Entity Type | Organization
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Legal Business Name | SUMMER K. BRUNSCHEEN, LLC
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Dates
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Enumeration Date | 08/04/2016
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Last Update Date | 08/04/2016
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Provider Practice Location Address
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Address Line | 2515 UNIVERSITY BLVD STE 102
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City | AMES
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State | IA
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Zip | 50010-8628
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Country | US
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Telephone | 515-450-7532
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Fax | 515-292-2514
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Provider Business Mailing Address
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Address Line | 810 YUMA AVE
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City | AMES
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State | IA
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Zip | 50014-3620
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Country | US
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Telephone | 515-450-7532
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Fax | 515-292-2514
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Authorized Official
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Title or Position | OWNER/SOLE MEMBER
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Name | DR. SUMMER KAYE BRUNSCHEEN
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Credential | PHD, LICPSYCHOLOGIST
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Telephone | 515-450-7532
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 001020
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License Number State | IA
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