=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093574022
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMBER LYNN BUNCH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2024
-----------------------------------------------------
Last Update Date | 03/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 511 CREEKSIDE CT
-----------------------------------------------------
City | HELENA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35080-3286
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-202-9685
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 511 CREEKSIDE CT
-----------------------------------------------------
City | HELENA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35080-3286
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | ALC004476
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------