Healthcare Provider Details

I. General information

NPI: 1043640543
Provider Name (Legal Business Name): CHARLEEN BUMBARGER MS/P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 BAUGHMAN RD
CURWENSVILLE PA
16833-7440
US

IV. Provider business mailing address

78 BAUGHMAN RD
CURWENSVILLE PA
16833-7440
US

V. Phone/Fax

Practice location:
  • Phone: 814-236-7477
  • Fax:
Mailing address:
  • Phone: 814-236-7477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: