| Mark Summerson, Phd, Llc | |
|
254 E Main St Suite 226 Pullman WA 99163-2678 | |
| (509) 330-5456 | |
| (509) 561-6229 |
| Full Name | Mark Summerson, Phd, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 254 E Main St, Pullman, Washington |
| Authorized Official Name and Position | Mark Summerson (PSYCHOLOGIST) |
| Authorized Official Contact | 5093305456 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mark Summerson, Phd, Llc 254 E Main St Suite 226 Pullman WA 99163-2678 Ph: (509) 330-5456 | Mark Summerson, Phd, Llc 254 E Main St Suite 226 Pullman WA 99163-2678 Ph: (509) 330-5456 |
| NPI Number | 1447604509 |
|---|---|
| Provider Enumeration Date | 04/14/2016 |
| Last Update Date | 04/14/2016 |
| Medicare PECOS PAC ID | 0941593750 |
|---|---|
| Medicare Enrollment ID | O20160801000610 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447604509 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PY00002258 (Washington) | Primary |
| Provider Name | Mark Summerson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1932122934 PECOS PAC ID: 9133312580 Enrollment ID: I20101019000329 |
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