Provider Demographics
NPI:1154669042
Name:BUNTIN, AMANDA LEE
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:LEE
Last Name:BUNTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6524 S MEMORIAL DR
Mailing Address - Street 2:UNIT E
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-3803
Mailing Address - Country:US
Mailing Address - Phone:918-948-2570
Mailing Address - Fax:
Practice Address - Street 1:6524 S MEMORIAL DR
Practice Address - Street 2:UNIT E
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-3803
Practice Address - Country:US
Practice Address - Phone:918-948-2570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional