Provider Demographics
NPI:1780691139
Name:SUMMY, WILLIAM BRADLEY (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRADLEY
Last Name:SUMMY
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 WINTHROP AVE.
Mailing Address - Street 2:SUITE 96
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-5614
Mailing Address - Country:US
Mailing Address - Phone:817-737-3888
Mailing Address - Fax:817-585-4841
Practice Address - Street 1:3309 WINTHROP AVE
Practice Address - Street 2:SUITE 96
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5614
Practice Address - Country:US
Practice Address - Phone:817-737-3888
Practice Address - Fax:817-585-4841
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13893101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional