Healthcare Provider Details

I. General information

NPI: 1891793014
Provider Name (Legal Business Name): REBECCA LYNN BUNCH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 SMITHVIEW DRIVE
MARYVILLE TN
37803
US

IV. Provider business mailing address

DEPARTMENT 888182
KNOXVILLE TN
37995-8182
US

V. Phone/Fax

Practice location:
  • Phone: 865-380-4390
  • Fax: 865-380-4396
Mailing address:
  • Phone: 800-355-3565
  • Fax: 423-714-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC1622
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: