Healthcare Provider Details

I. General information

NPI: 1083530398
Provider Name (Legal Business Name): BRENDA J BUNDRICK LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 FLAG WAY
COLORADO SPRINGS CO
80919-4416
US

IV. Provider business mailing address

5505 FLAG WAY
COLORADO SPRINGS CO
80919-4416
US

V. Phone/Fax

Practice location:
  • Phone: 281-814-5058
  • Fax:
Mailing address:
  • Phone: 281-814-5058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLCPP0024358
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: