Provider Demographics
NPI:1023595626
Name:CUMMINGS, BRYAN MATTHEW (MA, BCBA)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:MATTHEW
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3329 GRENACHE ST
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:CO
Mailing Address - Zip Code:80634-8889
Mailing Address - Country:US
Mailing Address - Phone:970-389-3081
Mailing Address - Fax:
Practice Address - Street 1:5400 W 11TH ST STE C
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4624
Practice Address - Country:US
Practice Address - Phone:970-736-5970
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-18-30911103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst