Provider Demographics
NPI:1932450889
Name:MICHAEL WESLEY SUMMERLIN PHD EK PSYCH
Entity type:Organization
Organization Name:MICHAEL WESLEY SUMMERLIN PHD EK PSYCH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:SUMMERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:949-677-3220
Mailing Address - Street 1:1441 SUPERIOR AVE
Mailing Address - Street 2:STE F
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-2704
Mailing Address - Country:US
Mailing Address - Phone:714-494-1867
Mailing Address - Fax:
Practice Address - Street 1:1441 SUPERIOR AVE
Practice Address - Street 2:STE F
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-2704
Practice Address - Country:US
Practice Address - Phone:714-494-1867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC0700X
CAPSY28000103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty