Provider Demographics
NPI:1538363320
Name:CUMMINGS, PHILLIP WENDELL (MS LBP)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:WENDELL
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:MS LBP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9021 ROLLING GREEN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-2054
Mailing Address - Country:US
Mailing Address - Phone:405-470-3741
Mailing Address - Fax:
Practice Address - Street 1:5131 CLASSEN CIR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4418
Practice Address - Country:US
Practice Address - Phone:405-767-1126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLBP 0308101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor