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General NPI Number Information
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NPI Number | 1073945671
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Entity Type | Individual
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Provider Name | TARA LYNN CUMMINGS PHD
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Gender | Female
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Dates
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Enumeration Date | 08/06/2013
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Last Update Date | 08/06/2013
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Provider Practice Location Address
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Address Line | 14214 LAURUS ESTATES LN
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City | CYPRESS
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State | TX
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Zip | 77429-8066
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Country | US
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Telephone | 713-213-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 14214 LAURUS ESTATES LANE
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City | CYPRESS
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State | TX
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Zip | 77429
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Country | US
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Telephone | 713-213-0100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 36004
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License Number State | TX
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