Provider Demographics
NPI:1043406655
Name:OTT, SUMMER D (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SUMMER
Middle Name:D
Last Name:OTT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
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Mailing Address - Street 1:6400 FANNIN
Mailing Address - Street 2:SUITE 1620
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2761
Mailing Address - Country:US
Mailing Address - Phone:713-704-9647
Mailing Address - Fax:713-704-0991
Practice Address - Street 1:6400 FANNIN ST
Practice Address - Street 2:SUITE 1620
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2761
Practice Address - Country:US
Practice Address - Phone:713-704-9647
Practice Address - Fax:713-704-0991
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2012-05-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX33628103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1043406655OtherBLUE CROSS BLUE SHIELD
TX192738601Medicaid
TX87447AOtherBCBS TX
TX192738602Medicaid
TXTXB131137Medicare PIN
TX8F7434Medicare PIN
TX192738602Medicaid
TX1043406655OtherBLUE CROSS BLUE SHIELD