Basic Information
| Provider Information | |||||||||
| NPI: | 1134370935 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUMER STATLER AEED, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 13385 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852673385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806099300 | ||||||||
| FaxNumber: | 4806099350 | ||||||||
| Practice Location | |||||||||
| Address1: | 7010 E ACOMA DR | ||||||||
| Address2: | SUITE A203 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852543553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806071022 | ||||||||
| FaxNumber: | 4803671160 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2008 | ||||||||
| LastUpdateDate: | 08/07/2015 | ||||||||
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| AuthorizedOfficialLastName: | AEED | ||||||||
| AuthorizedOfficialFirstName: | SUMER | ||||||||
| AuthorizedOfficialMiddleName: | STATLER | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4806071022 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | EDD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 3443 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.