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General NPI Number Information
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NPI Number | 1932747219
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Entity Type | Individual
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Provider Name | TARA SUMMERS PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 12/17/2019
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Last Update Date | 12/17/2019
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Provider Practice Location Address
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Address Line | 10535 HOSPITAL WAY
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City | MATHER
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State | CA
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Zip | 95655-4200
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Country | US
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Telephone | 916-843-9463
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Fax |
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Provider Business Mailing Address
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Address Line | 1720 R ST UNIT 310
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City | SACRAMENTO
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State | CA
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Zip | 95811-6778
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Country | US
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Telephone | 773-896-7880
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3733-57
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License Number State | WI
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