Healthcare Provider Details

I. General information

NPI: 1215793807
Provider Name (Legal Business Name): THERESA FUMIKO CUMMINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2023 CATO AVE STE 101
STATE COLLEGE PA
16801-2765
US

IV. Provider business mailing address

696 OAKWOOD AVE APT F
STATE COLLEGE PA
16803-2676
US

V. Phone/Fax

Practice location:
  • Phone: 814-308-8375
  • Fax:
Mailing address:
  • Phone: 814-280-0808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC016258
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: