Provider Demographics
NPI:1669466827
Name:CUMMINS, DAVID MICHAEL (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:CUMMINS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 W HAYS ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5025
Mailing Address - Country:US
Mailing Address - Phone:208-949-6765
Mailing Address - Fax:815-642-8485
Practice Address - Street 1:1310 W HAYS ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5025
Practice Address - Country:US
Practice Address - Phone:208-949-6765
Practice Address - Fax:815-642-8485
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY 2022232103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling