Provider Demographics
NPI:1316654155
Name:CUMMINS, TINA (MA, LPC-IT)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:CUMMINS
Suffix:
Gender:F
Credentials:MA, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 S COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-6152
Mailing Address - Country:US
Mailing Address - Phone:920-722-1805
Mailing Address - Fax:920-722-0142
Practice Address - Street 1:1509 S COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-6152
Practice Address - Country:US
Practice Address - Phone:920-722-1805
Practice Address - Fax:920-722-0142
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7153-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional