Provider Demographics
NPI:1114236288
Name:SUMMIT PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:SUMMIT PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:RHYNE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:903-954-0605
Mailing Address - Street 1:1488 COUNTY ROAD 3807
Mailing Address - Street 2:
Mailing Address - City:BULLARD
Mailing Address - State:TX
Mailing Address - Zip Code:75757-6808
Mailing Address - Country:US
Mailing Address - Phone:903-954-0605
Mailing Address - Fax:903-534-6518
Practice Address - Street 1:1810 SHILOH RD
Practice Address - Street 2:SUITE 801
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-2419
Practice Address - Country:US
Practice Address - Phone:903-954-0605
Practice Address - Fax:903-534-6518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-06
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34473103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty