Healthcare Provider Details

I. General information

NPI: 1598598724
Provider Name (Legal Business Name): JAIME BUNGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 SE 3RD ST
BEND OR
97702-1754
US

IV. Provider business mailing address

685 SE 3RD ST
BEND OR
97702-1754
US

V. Phone/Fax

Practice location:
  • Phone: 541-408-1029
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-24-3930
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number25-QMHA-R-6536
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number113065
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: