Provider Demographics
NPI:1235769506
Name:BUNGER, LEAH (MSED)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:BUNGER
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 S OXFORD DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-6754
Mailing Address - Country:US
Mailing Address - Phone:812-340-1635
Mailing Address - Fax:
Practice Address - Street 1:1117 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-3385
Practice Address - Country:US
Practice Address - Phone:812-340-1635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1587059101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool