Provider Demographics
NPI:1902459027
Name:CUMMINGS, KRISTIN (LMHC, NCC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 S DEER RUN
Mailing Address - Street 2:
Mailing Address - City:ELLETTSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47429-2039
Mailing Address - Country:US
Mailing Address - Phone:812-606-9026
Mailing Address - Fax:
Practice Address - Street 1:764 S DEER RUN
Practice Address - Street 2:
Practice Address - City:ELLETTSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47429-2039
Practice Address - Country:US
Practice Address - Phone:812-606-9026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002976A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200929150AMedicaid