Healthcare Provider Details

I. General information

NPI: 1659201077
Provider Name (Legal Business Name): ASHLYN ELIZABETH ROSE BUNCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7840 WASHINGTON AVE
KANSAS CITY KS
66112-2152
US

IV. Provider business mailing address

523 NW NORTH SHORE DR
LAKE WAUKOMIS MO
64151-1451
US

V. Phone/Fax

Practice location:
  • Phone: 913-563-6500
  • Fax:
Mailing address:
  • Phone: 816-719-5875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number05349-T
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: