Provider Demographics
NPI:1821288424
Name:CUMMINS, JOHN M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
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 1:500 W ROGERS BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070-1081
Mailing Address - Country:US
Mailing Address - Phone:918-396-9004
Mailing Address - Fax:918-396-2218
Practice Address - Street 1:500 W ROGERS BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070-1081
Practice Address - Country:US
Practice Address - Phone:918-396-9004
Practice Address - Fax:918-396-2218
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1209103TH0100X
TX2-3601103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling