Provider Demographics
NPI:1609320902
Name:SUMMER K. BRUNSCHEEN, LLC
Entity Type:Organization
Organization Name:SUMMER K. BRUNSCHEEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMMER
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:BRUNSCHEEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LICPSYCHOLOGIST
Authorized Official - Phone:515-450-7532
Mailing Address - Street 1:810 YUMA AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-3620
Mailing Address - Country:US
Mailing Address - Phone:515-450-7532
Mailing Address - Fax:515-292-2514
Practice Address - Street 1:2515 UNIVERSITY BLVD STE 102
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-8628
Practice Address - Country:US
Practice Address - Phone:515-450-7532
Practice Address - Fax:515-292-2514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001020103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty