Healthcare Provider Details

I. General information

NPI: 1245606409
Provider Name (Legal Business Name): BRANDON S BUNKER LCMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4516 S 700 E STE 275
MURRAY UT
84107-8605
US

IV. Provider business mailing address

232 E BROWNING AVE
SALT LAKE CITY UT
84115-5410
US

V. Phone/Fax

Practice location:
  • Phone: 801-655-3442
  • Fax:
Mailing address:
  • Phone: 801-655-3442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701013816
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC.LH.70065009
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8287475-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: