Provider Demographics
NPI: | 1639931322 |
---|---|
Name: | RONALD R. SUMMERHILL, PLLC |
Entity Type: | Organization |
Organization Name: | RONALD R. SUMMERHILL, PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO/PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | RONALD |
Authorized Official - Middle Name: | RAYMOND |
Authorized Official - Last Name: | SUMMERHILL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PSYD |
Authorized Official - Phone: | 480-580-3234 |
Mailing Address - Street 1: | 3066 BERNA WAY |
Mailing Address - Street 2: | |
Mailing Address - City: | MORRISTOWN |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37814-5640 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 480-580-3234 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3066 BERNA WAY |
Practice Address - Street 2: | |
Practice Address - City: | MORRISTOWN |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37814-5640 |
Practice Address - Country: | US |
Practice Address - Phone: | 480-580-3234 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2024-01-29 |
Last Update Date: | 2024-01-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
No | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | Group - Multi-Specialty | |
No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | Group - Multi-Specialty |
No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
No | 103TF0200X | Behavioral Health & Social Service Providers | Psychologist | Forensic | Group - Multi-Specialty |
No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities | Group - Multi-Specialty |
No | 103TS0200X | Behavioral Health & Social Service Providers | Psychologist | School | Group - Multi-Specialty |