Provider Demographics
NPI:1396307971
Name:CUMMINS, STEPHANIE J (LADCS, MENTAL HEALTH)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:CUMMINS
Suffix:
Gender:F
Credentials:LADCS, MENTAL HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:MN
Mailing Address - Zip Code:56044-4031
Mailing Address - Country:US
Mailing Address - Phone:320-455-1835
Mailing Address - Fax:
Practice Address - Street 1:940 IVY HILLS RD
Practice Address - Street 2:
Practice Address - City:BELLE PLAINE
Practice Address - State:MN
Practice Address - Zip Code:56011-5125
Practice Address - Country:US
Practice Address - Phone:320-455-1835
Practice Address - Fax:320-407-0501
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2022-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304824101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty