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General NPI Number Information
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NPI Number | 1376045583
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Entity Type | Individual
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Provider Name | BRITTANY ANNE BUNTON LCPC
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Gender | Female
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Dates
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Enumeration Date | 03/03/2018
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Last Update Date | 06/18/2020
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Provider Practice Location Address
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Address Line | 5702 ELAINE DR. SUITE 106
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City | ROCKFORD
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State | IL
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Zip | 61108-2458
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Country | US
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Telephone | 815-904-2188
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Fax | 815-277-1246
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Provider Business Mailing Address
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Address Line | 5702 ELAINE DR. SUITE 106
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City | ROCKFORD
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State | IL
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Zip | 61108-2458
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Country | US
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Telephone | 815-904-2188
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Fax | 815-277-1246
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 178012309
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180011507
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License Number State | IL
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