Provider Demographics
NPI:1689062085
Name:CUMMINS-HASTY, DOREEN ANNE (LPC)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:ANNE
Last Name:CUMMINS-HASTY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 CAPELLA CIR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-3781
Mailing Address - Country:US
Mailing Address - Phone:541-944-0150
Mailing Address - Fax:
Practice Address - Street 1:149 CLEAR CREEK DR UNIT 101
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1882
Practice Address - Country:US
Practice Address - Phone:541-944-0150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3663101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC3663OtherOREGON LICENSE