Provider Demographics
NPI:1962063545
Name:CUMMINS, LORYN (MA)
Entity type:Individual
Prefix:
First Name:LORYN
Middle Name:
Last Name:CUMMINS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1437
Mailing Address - Street 2:
Mailing Address - City:SISTERS
Mailing Address - State:OR
Mailing Address - Zip Code:97759-1437
Mailing Address - Country:US
Mailing Address - Phone:541-719-8544
Mailing Address - Fax:888-280-0531
Practice Address - Street 1:257 S PINE ST
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759-1680
Practice Address - Country:US
Practice Address - Phone:541-719-8544
Practice Address - Fax:888-280-0531
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YP2500X, 101Y00000X
ORC6531101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor