Provider Demographics
NPI:1669297420
Name:CUMMINS, CRYSTAL (MED)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:CUMMINS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:SPEELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:PO BOX 1513
Mailing Address - Street 2:
Mailing Address - City:POPLAR
Mailing Address - State:MT
Mailing Address - Zip Code:59255-1513
Mailing Address - Country:US
Mailing Address - Phone:605-216-1158
Mailing Address - Fax:
Practice Address - Street 1:215 N 5TH ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MT
Practice Address - Zip Code:59213
Practice Address - Country:US
Practice Address - Phone:406-786-3311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT74573101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional