Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1265664528 |
---|---|
Provider Name | Sean Keith Cummins |
First Address | Cottage Grove, OR 97424-1416 |
Second Address | Cottage Grove, OR 97424-1416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2009 |
Last Update Date | 27/07/2016 |