Healthcare Provider Details

I. General information

NPI: 1982305686
Provider Name (Legal Business Name): MELANIE LYNN BUGNASKI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 W MAIN ST STE 506-7
KALAMAZOO MI
49009-9262
US

IV. Provider business mailing address

3109 SUNFIELD ST
KALAMAZOO MI
49004-1851
US

V. Phone/Fax

Practice location:
  • Phone: 269-929-7717
  • Fax:
Mailing address:
  • Phone: 269-929-7717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451022564
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401224444
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: