Healthcare Provider Details

I. General information

NPI: 1407761067
Provider Name (Legal Business Name): MA PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 SOUTH ST
BARRE MA
01005-8890
US

IV. Provider business mailing address

PO BOX 604
TEMPLETON MA
01468-0604
US

V. Phone/Fax

Practice location:
  • Phone: 978-627-7819
  • Fax:
Mailing address:
  • Phone: 978-627-7819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL CLYDE CUMMIGNS
Title or Position: PROVIDER/OWNER
Credential: LMHC, LPC
Phone: 978-627-7819