MEDICARE: DOREEN ANNE CUMMINS-HASTY LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	C3663	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C3663	OTHER	OR	OREGON LICENSE

General Provider Information

NPI Number	:	1689062085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOREEN ANNE CUMMINS-HASTY LPC

Provider Business Mailing Address
First Line	:	816 CAPELLA CIR
Second Line	:
City	:	ASHLAND
State	:	OR
Zip	:	97520-3781
Country	:	US
Telephone Number	:	541-944-0150
Fax Number	:

Provider Business Practice Location Address
First Line	:	149 CLEAR CREEK DR UNIT 101
Second Line	:
City	:	ASHLAND
State	:	OR
Zip	:	97520-1882
Country	:	US
Telephone Number	:	541-944-0150
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2015
Last Update Date	:	01/07/2015

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