Provider Demographics
NPI:1942584016
Name:CUMMINGS, KATHRINE DAWN (LMSW)
Entity Type:Individual
Prefix:
First Name:KATHRINE
Middle Name:DAWN
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 HILINE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2947
Mailing Address - Country:US
Mailing Address - Phone:208-478-9081
Mailing Address - Fax:208-478-4999
Practice Address - Street 1:1070 HILINE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2947
Practice Address - Country:US
Practice Address - Phone:208-478-9081
Practice Address - Fax:208-478-4999
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW - 31673101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health