Healthcare Provider Details

I. General information

NPI: 1518398429
Provider Name (Legal Business Name): KRISTEN BAMBULE MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 12/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 W PHILADELPHIA ST
YORK PA
17401-6509
US

IV. Provider business mailing address

285 SILVER MAPLE CT
MOUNT WOLF PA
17347-8906
US

V. Phone/Fax

Practice location:
  • Phone: 717-845-2425
  • Fax: 717-845-2682
Mailing address:
  • Phone: 717-324-7737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC007246
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: