Provider Demographics
NPI:1205687233
Name:CRYSTAL CUMMINGS
Entity type:Organization
Organization Name:CRYSTAL CUMMINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:JEANINE
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:805-312-0777
Mailing Address - Street 1:190 TOWNSITE PROMENADE
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-7582
Mailing Address - Country:US
Mailing Address - Phone:805-312-0777
Mailing Address - Fax:
Practice Address - Street 1:190 TOWNSITE PROMENADE
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-7582
Practice Address - Country:US
Practice Address - Phone:805-312-0777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRYSTAL CUMMINGS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-28
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health