Healthcare Provider Details

I. General information

NPI: 1972114346
Provider Name (Legal Business Name): EMILY BUMGARNER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 HOSPITAL DR STE 302
STATE COLLEGE PA
16803-5500
US

IV. Provider business mailing address

155 WELLNESS WAY
STATE COLLEGE PA
16803-6702
US

V. Phone/Fax

Practice location:
  • Phone: 814-278-4680
  • Fax: 814-235-1523
Mailing address:
  • Phone: 814-231-7000
  • Fax: 814-231-7098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC012577
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: