MEDICARE: DR. SAMUEL BUNVILLE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	178018649	IL

General Provider Information

NPI Number	:	1093508582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL BUNVILLE PH.D.

Provider Business Mailing Address
First Line	:	1451 W 115TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-4464
Country	:	US
Telephone Number	:	708-259-4977
Fax Number	:

Provider Business Practice Location Address
First Line	:	1451 W 115TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-4464
Country	:	US
Telephone Number	:	708-259-4977
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2025
Last Update Date	:	04/11/2026

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Directions to “ DR. SAMUEL BUNVILLE PH.D.” Practice Location

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