Provider Demographics
NPI:1285273706
Name:SUMMIT PSYCHOLOGICAL SERVICES, A PROFESSIONAL PSYCH
Entity type:Organization
Organization Name:SUMMIT PSYCHOLOGICAL SERVICES, A PROFESSIONAL PSYCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-264-4909
Mailing Address - Street 1:222 N MOUNTAIN AVE STE 110B
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5714
Mailing Address - Country:US
Mailing Address - Phone:909-999-5220
Mailing Address - Fax:
Practice Address - Street 1:222 N MOUNTAIN AVE STE 110B
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5714
Practice Address - Country:US
Practice Address - Phone:909-999-5220
Practice Address - Fax:909-781-2422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-01
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty