Individual
DR. MARY K SUMMERS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
8925 BROADWAY, MERRILLVILLE, IN 46410-7039
(219) 736-6220
Mailing address
1819 FOREST LN, CROWN POINT, IN 46307-9319
(219) 988-2903
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20040365
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
I011554
CHAMPUS
IN
Enumeration date
05/05/2006
Last updated
07/08/2007
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