Provider Demographics
NPI:1740367051
Name:KUMMERER, GENE HENRY II (MDIV, MS, LPC)
Entity type:Individual
Prefix:
First Name:GENE
Middle Name:HENRY
Last Name:KUMMERER
Suffix:II
Gender:M
Credentials:MDIV, MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 W LYNN ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-3978
Mailing Address - Country:US
Mailing Address - Phone:512-897-4787
Mailing Address - Fax:
Practice Address - Street 1:1300 W LYNN ST
Practice Address - Street 2:SUITE 214
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-3978
Practice Address - Country:US
Practice Address - Phone:512-897-4787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11813101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113023902Medicaid