Healthcare Provider Details

I. General information

NPI: 1639410657
Provider Name (Legal Business Name): HEIDI ANN BUNKER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2013
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML 3014
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE ML 5021
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4788
  • Fax: 513-636-4283
Mailing address:
  • Phone: 513-636-4225
  • Fax: 513-636-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0700906
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: