Healthcare Provider Details

I. General information

NPI: 1861328650
Provider Name (Legal Business Name): JESSICA BUNGART THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 S CUSTER ST
SANDUSKY MI
48471-1209
US

IV. Provider business mailing address

228 S CUSTER ST
SANDUSKY MI
48471-1209
US

V. Phone/Fax

Practice location:
  • Phone: 810-404-9772
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JESSICA BUNGART
Title or Position: PROFESSIONAL COUNSELOR/OWNER
Credential: LPC
Phone: 810-404-9772