Provider Demographics
NPI:1487411120
Name:CUMPTON, MARK STERLING
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:STERLING
Last Name:CUMPTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 FIR ST STE 327
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-2663
Mailing Address - Country:US
Mailing Address - Phone:541-709-6280
Mailing Address - Fax:
Practice Address - Street 1:105 FIR ST STE 327
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2663
Practice Address - Country:US
Practice Address - Phone:541-709-6280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)