MEDICARE: SUMMERLIN PSYCHOLOGY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1770288789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMERLIN PSYCHOLOGY LLC

Provider Business Mailing Address
First Line	:	11035 LAVENDER HILL DR # 160-605
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-2955
Country	:	US
Telephone Number	:	702-758-4587
Fax Number	:

Provider Business Practice Location Address
First Line	:	10501 W GOWAN RD STE 260
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6603
Country	:	US
Telephone Number	:	702-758-4587
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	DR. SUNG CHO
Credential	:	PSYD
Telephone Number	:	702-758-4587

Provider Enumeration Date	:	03/31/2023
Last Update Date	:	03/31/2023

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Directions to “SUMMERLIN PSYCHOLOGY LLC ” Practice Location

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