Provider Demographics
NPI:1225439342
Name:CUMMINS, JAY L (LPC)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:L
Last Name:CUMMINS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 OGLESBY AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-4618
Mailing Address - Country:US
Mailing Address - Phone:309-585-0241
Mailing Address - Fax:
Practice Address - Street 1:706 OGLESBY AVE STE 112
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-4618
Practice Address - Country:US
Practice Address - Phone:309-585-0241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.008398101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional