MEDICARE: JOSEPH ANDREW BUNTON SR. BA

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

General Provider Information

NPI Number	:	1225358724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH ANDREW BUNTON SR. BA

Provider Business Mailing Address
First Line	:	4714 CREEK CT
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-4609
Country	:	US
Telephone Number	:	405-733-5527
Fax Number	:

Provider Business Practice Location Address
First Line	:	4714 CREEK CT
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-4609
Country	:	US
Telephone Number	:	405-733-5527
Fax Number	:

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

Provider Enumeration Date	:	06/07/2010
Last Update Date	:	06/07/2010

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