MEDICARE: REBECCA LYNN BUNCH LPC

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	101Y00000X	Counselor	LPC1622	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5441749	OTHER	TN	TENNCARE

General Provider Information

NPI Number	:	1891793014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA LYNN BUNCH LPC

Provider Business Mailing Address
First Line	:	DEPARTMENT 888182
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37995-8182
Country	:	US
Telephone Number	:	800-355-3565
Fax Number	:	423-714-2355

Provider Business Practice Location Address
First Line	:	627 SMITHVIEW DRIVE
Second Line	:
City	:	MARYVILLE
State	:	TN
Zip	:	37803
Country	:	US
Telephone Number	:	865-380-4390
Fax Number	:	865-380-4396

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	08/17/2007

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