MEDICARE: CRYSTAL JEANINE CUMMINGS LMFT

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	106H00000X	Marriage & Family Therapist	MFC 49530	CA

General Provider Information

NPI Number	:	1134392954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL JEANINE CUMMINGS LMFT

Provider Business Mailing Address
First Line	:	190 TOWNSITE PROMENADE
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-7582
Country	:	US
Telephone Number	:	805-312-0777
Fax Number	:

Provider Business Practice Location Address
First Line	:	190 TOWNSITE PROMENADE
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-7582
Country	:	US
Telephone Number	:	805-312-0777
Fax Number	:

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

Provider Enumeration Date	:	04/13/2008
Last Update Date	:	10/31/2024

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