Healthcare Provider Details

I. General information

NPI: 1497556237
Provider Name (Legal Business Name): BECKY BUNKER LMHC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 SANTO DOMINGO AVE SW
PALM BAY FL
32908-7470
US

IV. Provider business mailing address

615 SANTO DOMINGO AVE SW
PALM BAY FL
32908-7470
US

V. Phone/Fax

Practice location:
  • Phone: 508-353-0169
  • Fax:
Mailing address:
  • Phone: 508-353-0169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BECKY BUNKER
Title or Position: BUSINESS OWNER
Credential: LMHC
Phone: 774-764-9000