Healthcare Provider Details

I. General information

NPI: 1881351799
Provider Name (Legal Business Name): SARAH ANN BUMGARNER MS, NCC, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2021
Last Update Date: 11/26/2021
Certification Date: 11/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 WASHINGTON ST
MONTICELLO MN
55362-8815
US

IV. Provider business mailing address

318 KAREN LN
BIG LAKE MN
55309
US

V. Phone/Fax

Practice location:
  • Phone: 763-295-4001
  • Fax: 763-295-5086
Mailing address:
  • Phone: 763-334-8806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2965
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: