Healthcare Provider Details

I. General information

NPI: 1841439940
Provider Name (Legal Business Name): DENNIS MICHAEL BUMGARNER L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8311 W 10TH ST
INDIANAPOLIS IN
46234-1808
US

IV. Provider business mailing address

8311 W 10TH ST
INDIANAPOLIS IN
46234-1808
US

V. Phone/Fax

Practice location:
  • Phone: 317-271-8700
  • Fax: 317-271-8790
Mailing address:
  • Phone: 317-271-8700
  • Fax: 317-271-8790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34000592A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: