Healthcare Provider Details

I. General information

NPI: 1346206232
Provider Name (Legal Business Name): KARLA JAN BUNCH M.S., L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5265 S BUSINESS HIGHWAY 71
PINEVILLE MO
64856-8505
US

IV. Provider business mailing address

PO BOX 2526
JOPLIN MO
64803-2526
US

V. Phone/Fax

Practice location:
  • Phone: 417-223-5300
  • Fax:
Mailing address:
  • Phone: 417-347-7600
  • Fax: 417-347-0293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2001018039
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2001018039
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: