MEDICARE: DENISE ANN CUMMINGS FAGAN LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH 9645	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023254950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE ANN CUMMINGS FAGAN LMHC

Provider Business Mailing Address
First Line	:	7364 KATHLEEN RD # 1021
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33810-4495
Country	:	US
Telephone Number	:	813-768-3557
Fax Number	:

Provider Business Practice Location Address
First Line	:	7364 KATHLEEN RD # 1021
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33810-4495
Country	:	US
Telephone Number	:	813-768-3557
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/24/2008
Last Update Date	:	04/03/2026

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