Mary Beth Summerville, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2018043945 Issued in MO

Practice address

425 S Woods Mill Rd Ste 150
Town and Country, MO 63017-9528

Phone

(636) 939-2550

Fax

(314) 627-4978

NPI assigned

Oct 17, 2006

Last updated

Jan 29, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Psychological and Behavioral Consultants LLCGroup PAC ID 0446243760, 595 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mary.summerville.d1.p1@direct.affiniahealthcare.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Psychological & Behavioral Consultants, LLC

  dba LifeStance Health

  • Psychiatry Physician
  • Beachwood, OH
  • NPI 1811915713

  Clinical, MO

  Medicare reassignment Care Compare group NPD
• Affinia Healthcare

  • Federally Qualified Health Center (FQHC)
  • Saint Louis, MO
  • NPI 1902816077

  Multi-Specialty

  Medicare reassignment NPD
• Child and Family Psychotherapy Center

  • Psychologist
  • Cartersville, GA
  • NPI 1356608459
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769644800000",
    "number": "1508946195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 S WOODS MILL RD STE 150",
            "city": "TOWN AND COUNTRY",
            "state": "MO",
            "postal_code": "630179528",
            "telephone_number": "636-939-2550",
            "fax_number": "314-627-4978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 S WOODS MILL RD STE 150",
            "city": "TOWN AND COUNTRY",
            "state": "MO",
            "postal_code": "630179528",
            "telephone_number": "636-939-2550",
            "fax_number": "314-627-4978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUMMERVILLE",
        "first_name": "MARY",
        "middle_name": "BETH",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-17",
        "last_updated": "2026-01-29",
        "certification_date": "2026-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "2018043945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jill Solomon, M.S.,CCC-SLP
• St Louis Childrens Hospital (Children's Hospital Specialty Care Center Pharmacy)
• Randall Sterkel, M.D.
• Chelsea Martin Straight, RDN, LDN
• Audrey Stutsman, PSYD
• Tandc Op LLC (Town and Country Health & Rehab)
• United Physicians Group, LLC
• Warby Parker Inc.
• Washington University
• Maya Wasserstrom, LCSW

• Clinical Psychologist in Town and Country, MO
• Providers in Town and Country, MO by specialty
• Clinical Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.