Provider Demographics
NPI:1336980937
Name:SUMMERLAND MENTAL HEALTH LLC
Entity type:Organization
Organization Name:SUMMERLAND MENTAL HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENALI
Authorized Official - Middle Name:
Authorized Official - Last Name:BRICHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-886-1219
Mailing Address - Street 1:8705 NAUTICAL BAY LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3502
Mailing Address - Country:US
Mailing Address - Phone:614-886-1219
Mailing Address - Fax:
Practice Address - Street 1:2400 N TENAYA WAY STE 131
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0420
Practice Address - Country:US
Practice Address - Phone:702-608-6403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-05
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty