Healthcare Provider Details

I. General information

NPI: 1992270607
Provider Name (Legal Business Name): EMILIA BUMGARDNER LMFTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 E 29TH AVE STE 200
SPOKANE WA
99203-3948
US

IV. Provider business mailing address

3020 S CLINTON RD APT 15
SPOKANE VALLEY WA
99216-0182
US

V. Phone/Fax

Practice location:
  • Phone: 888-364-5977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMG61627926
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: