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General NPI Number Information
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NPI Number | 1891024741
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Entity Type | Individual
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Provider Name | DAVID J BUMGARNER PHD
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Gender | Male
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Dates
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Enumeration Date | 12/23/2009
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 2203 MCKINLEY RD
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City | JOHNSON CITY
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State | TN
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Zip | 37604
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Country | US
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Telephone | 423-926-1171
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4000
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City | MOUNTAIN HOME
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State | TN
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Zip | 37684-4000
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Country | US
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Telephone | 423-926-1171
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Fax |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | P0000003474
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License Number State | TN
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