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NPI Code Detail

MEDICARE: CLARENCE KEON BUMPAS

MEDICARE: CLARENCE KEON BUMPAS
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
1101Y00000XCounselorNLC.0108216CO

General Provider Information

NPI Number : 1144871492
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLARENCE KEON BUMPAS
Provider Business Mailing Address
First Line : 511 COMANCHE VILLAGE DR
Second Line :
City : FOUNTAIN
State : CO
Zip : 80817-1667
Country : US
Telephone Number : 719-666-4134
Fax Number :
Provider Business Practice Location Address
First Line : 2565 AIRPORT RD
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80910-3119
Country : US
Telephone Number : 719-632-3570
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2019
Last Update Date : 09/26/2019

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