Provider Demographics
NPI:1619089927
Name:CUMMINS, HEIDI MARLENE (LBSW, EIS)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:MARLENE
Last Name:CUMMINS
Suffix:
Gender:F
Credentials:LBSW, EIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8266
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76307-8266
Mailing Address - Country:US
Mailing Address - Phone:940-696-6212
Mailing Address - Fax:940-696-6210
Practice Address - Street 1:1709 10TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5010
Practice Address - Country:US
Practice Address - Phone:940-696-6212
Practice Address - Fax:940-696-6210
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32459104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111408402Medicaid
TX111408401Medicaid
TX456554Medicare ID - Type UnspecifiedMEDICARE #
TX00T22YOtherBCBS #