Healthcare Provider Details

I. General information

NPI: 1023807856
Provider Name (Legal Business Name): DONA BUMGARNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 FRONT ST STE 370
SANTA CRUZ CA
95060-4584
US

IV. Provider business mailing address

102 GRANDVIEW ST
SANTA CRUZ CA
95060-3015
US

V. Phone/Fax

Practice location:
  • Phone: 831-713-5609
  • Fax:
Mailing address:
  • Phone: 408-802-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAMFT152960
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: