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General NPI Number Information
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NPI Number | 1780691139
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Entity Type | Individual
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Provider Name | WILLIAM BRADLEY SUMMY PH.D., L.P.C.
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Gender | Male
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 09/05/2012
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Provider Practice Location Address
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Address Line | 3309 WINTHROP AVE SUITE 96
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City | FORT WORTH
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State | TX
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Zip | 76116-5614
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Country | US
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Telephone | 817-737-3888
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Fax | 817-585-4841
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Provider Business Mailing Address
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Address Line | 3309 WINTHROP AVE. SUITE 96
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City | FORT WORTH
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State | TX
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Zip | 76116-5614
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Country | US
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Telephone | 817-737-3888
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Fax | 817-585-4841
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 13893
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License Number State | TX
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