Provider Demographics
NPI:1215793807
Name:CUMMINS, THERESA FUMIKO
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:FUMIKO
Last Name:CUMMINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 OAKWOOD AVE APT F
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-2676
Mailing Address - Country:US
Mailing Address - Phone:814-280-0808
Mailing Address - Fax:
Practice Address - Street 1:2023 CATO AVE STE 101
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-2765
Practice Address - Country:US
Practice Address - Phone:814-308-8375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC016258101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional