Provider Demographics
NPI:1104186592
Name:CUMMINGS, MELINDA
Entity Type:Individual
Prefix:MISS
First Name:MELINDA
Middle Name:
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 E 600 N
Mailing Address - Street 2:#16
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-1769
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 N 195 E
Practice Address - Street 2:#16
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-1133
Practice Address - Country:US
Practice Address - Phone:571-274-0093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst