Healthcare Provider Details

I. General information

NPI: 1952798381
Provider Name (Legal Business Name): CAROL BUMGARDNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4741 ENGLE RD
CARMICHAEL CA
95608-2223
US

IV. Provider business mailing address

4741 ENGLE RD
CARMICHAEL CA
95608-2223
US

V. Phone/Fax

Practice location:
  • Phone: 916-977-0949
  • Fax: 916-977-0423
Mailing address:
  • Phone: 916-977-0949
  • Fax: 916-977-0423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: