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General NPI Number Information
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NPI Number | 1790110583
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Entity Type | Individual
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Provider Name | ANGIE HARDAGE-BUNDY MA, LMLP
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Gender | Female
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Dates
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Enumeration Date | 09/11/2013
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Last Update Date | 12/16/2013
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Provider Practice Location Address
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Address Line | 10500 E BERKELEY SQUARE PKWY SUITE 103
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City | WICHITA
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State | KS
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Zip | 67206-6815
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Country | US
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Telephone | 316-640-1557
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Fax | 316-636-4522
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Provider Business Mailing Address
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Address Line | 908 N GATEWOOD CT
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City | WICHITA
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State | KS
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Zip | 67206-4009
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Country | US
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Telephone | 316-640-1557
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Fax | 316-636-4522
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2355
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License Number State | KS
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