Healthcare Provider Details

I. General information

NPI: 1386068526
Provider Name (Legal Business Name): MICHAEL CLYDE CUMMINGS LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1069 CENTRAL ST
LEOMINSTER MA
01453-4805
US

IV. Provider business mailing address

1069 CENTRAL ST
LEOMINSTER MA
01453-4805
US

V. Phone/Fax

Practice location:
  • Phone: 978-728-4957
  • Fax: 978-798-1366
Mailing address:
  • Phone: 978-728-4957
  • Fax: 978-798-1366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12064
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: