Healthcare Provider Details

I. General information

NPI: 1194735100
Provider Name (Legal Business Name): MICHAEL ALAN CUMMINGS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 RANDALL LN
TAOS NM
87571-5211
US

IV. Provider business mailing address

338 RANDALL LN
TAOS NM
87571-5211
US

V. Phone/Fax

Practice location:
  • Phone: 575-758-0345
  • Fax: 575-758-0346
Mailing address:
  • Phone: 575-758-0345
  • Fax: 575-758-0346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number737
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number737
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number737
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: