Provider Demographics
NPI:1871602078
Name:CUNNINGHAM, THOMAS (LLP)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50449
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49005-0449
Mailing Address - Country:US
Mailing Address - Phone:269-978-0887
Mailing Address - Fax:269-978-2757
Practice Address - Street 1:3311 GREENLEAF BLVD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-2516
Practice Address - Country:US
Practice Address - Phone:269-978-0887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2021-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361002417103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical