Provider Demographics
NPI:1447604509
Name:MARK SUMMERSON, PHD, LLC
Entity Type:Organization
Organization Name:MARK SUMMERSON, PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:509-330-5456
Mailing Address - Street 1:254 E MAIN ST
Mailing Address - Street 2:SUITE 226
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-2678
Mailing Address - Country:US
Mailing Address - Phone:509-330-5456
Mailing Address - Fax:509-561-6229
Practice Address - Street 1:254 E MAIN ST
Practice Address - Street 2:SUITE 226
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-2678
Practice Address - Country:US
Practice Address - Phone:509-330-5456
Practice Address - Fax:509-561-6229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002258103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty