Provider Demographics
NPI:1770719528
Name:SUMMY, LLOYD G (M ED BCBA)
Entity type:Individual
Prefix:MR
First Name:LLOYD
Middle Name:G
Last Name:SUMMY
Suffix:
Gender:M
Credentials:M ED BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:594 GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-3500
Mailing Address - Country:US
Mailing Address - Phone:817-925-2979
Mailing Address - Fax:
Practice Address - Street 1:594 GARDEN CT
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-3500
Practice Address - Country:US
Practice Address - Phone:817-925-2979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-10-3867103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst