Provider Demographics
NPI:1598581761
Name:SUMMERHILL, CRYSTAL LENIQUE (RBT)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LENIQUE
Last Name:SUMMERHILL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3627 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-7198
Mailing Address - Country:US
Mailing Address - Phone:469-343-6390
Mailing Address - Fax:
Practice Address - Street 1:108 W RUSSELL ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5360
Practice Address - Country:US
Practice Address - Phone:817-694-5073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-24-342440106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician