Provider Demographics
NPI:1083745152
Name:SUMMERLIN, MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:SUMMERLIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 W ORANGEWOOD AVE
Mailing Address - Street 2:STE. 105
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2009
Mailing Address - Country:US
Mailing Address - Phone:714-494-1867
Mailing Address - Fax:
Practice Address - Street 1:1940 W ORANGEWOOD AVE
Practice Address - Street 2:STE. 105
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2009
Practice Address - Country:US
Practice Address - Phone:714-494-1867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43233106H00000X
CAPSY28000103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist