Provider Demographics
NPI:1609925924
Name:SUMMERLIN, MARY LUE (ED D)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:LUE
Last Name:SUMMERLIN
Suffix:
Gender:F
Credentials:ED D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 LAKEVILLE DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2067
Mailing Address - Country:US
Mailing Address - Phone:281-743-7712
Mailing Address - Fax:
Practice Address - Street 1:1525 LAKEVILLE DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2067
Practice Address - Country:US
Practice Address - Phone:281-743-7712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U70XOtherBCBS