Provider Demographics
NPI:1548355969
Name:CUNNINGHAM, JOHN (LMFT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 PINE ST.
Mailing Address - Street 2:
Mailing Address - City:MT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067
Mailing Address - Country:US
Mailing Address - Phone:530-926-5888
Mailing Address - Fax:530-926-5888
Practice Address - Street 1:705 PINE ST.
Practice Address - Street 2:
Practice Address - City:MT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067
Practice Address - Country:US
Practice Address - Phone:530-926-5888
Practice Address - Fax:530-926-5888
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT ME23888106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist