Provider Demographics
NPI:1194735100
Name:CUMMINGS, MICHAEL ALAN (PHD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ALAN
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 RANDALL LN
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-5211
Mailing Address - Country:US
Mailing Address - Phone:575-758-0345
Mailing Address - Fax:575-758-0346
Practice Address - Street 1:338 RANDALL LN
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-5211
Practice Address - Country:US
Practice Address - Phone:575-758-0345
Practice Address - Fax:575-758-0346
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM737103T00000X, 103TC0700X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM100709OtherVALUE OPTIONS NM
NM00R624OtherBLUE CROSS BLUE SHIELD
NM00000Z2629Medicaid
NM1194735100OtherMEDICARE
NM1194735100OtherMEDICARE