Provider Demographics
NPI:1548983836
Name:EK PSYCH - EMOTIVE KNOWLEDGE PSYCHOLOGY A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:EK PSYCH - EMOTIVE KNOWLEDGE PSYCHOLOGY A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
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:PHD
Authorized Official - Phone:714-494-1867
Mailing Address - Street 1:1707 MORNING CANYON RD
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-2826
Mailing Address - Country:US
Mailing Address - Phone:714-494-1867
Mailing Address - Fax:
Practice Address - Street 1:1441 SUPERIOR AVE STE F
Practice Address - Street 2:
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:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty