Provider Demographics
NPI:1770288789
Name:SUMMERLIN PSYCHOLOGY LLC
Entity type:Organization
Organization Name:SUMMERLIN PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:702-758-4587
Mailing Address - Street 1:11035 LAVENDER HILL DR # 160-605
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2955
Mailing Address - Country:US
Mailing Address - Phone:702-758-4587
Mailing Address - Fax:
Practice Address - Street 1:10501 W GOWAN RD STE 260
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-6603
Practice Address - Country:US
Practice Address - Phone:702-758-4587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty