Provider Demographics
NPI:1386630275
Name:CUMMINS, JEFFREY S (LCSW)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:CUMMINS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3538 LYNN AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-4340
Mailing Address - Country:US
Mailing Address - Phone:406-652-2158
Mailing Address - Fax:406-652-2158
Practice Address - Street 1:409 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-1743
Practice Address - Country:US
Practice Address - Phone:406-259-8633
Practice Address - Fax:406-254-0091
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT700LCSW104100000X
CALCS 194491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT71345OtherBLUE CROSS BLUE SHIELD
MT0503914Medicaid