Provider Demographics
NPI:1295759272
Name:CUMMINGS, TERRY MICHAEL (LICENSED CLINICAL SO)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:MICHAEL
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:LICENSED CLINICAL SO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71-777 SAN JACINTO DRIVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270
Mailing Address - Country:US
Mailing Address - Phone:760-285-5043
Mailing Address - Fax:760-345-7423
Practice Address - Street 1:71-777 SAN JACINTO DRIVE
Practice Address - Street 2:SUITE 204
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270
Practice Address - Country:US
Practice Address - Phone:760-285-5043
Practice Address - Fax:760-345-7423
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 147411041C0700X
CALCSW147411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical