Healthcare Provider Details

I. General information

NPI: 1114851680
Provider Name (Legal Business Name): JAXON DAVID BUNTING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 PENN CENTER BLVD APT 1105
PITTSBURGH PA
15235-5332
US

IV. Provider business mailing address

1100 PENN CENTER BLVD APT 1105
PITTSBURGH PA
15235-5332
US

V. Phone/Fax

Practice location:
  • Phone: 740-215-3468
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberUZ952576
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: