Provider Demographics
NPI:1295010759
Name:BUMSTEAD, MARY JO (MFTI)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:JO
Last Name:BUMSTEAD
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14938 CAMDEN AVE # 44
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-2801
Mailing Address - Country:US
Mailing Address - Phone:530-570-7120
Mailing Address - Fax:
Practice Address - Street 1:530 SOQUEL AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2301
Practice Address - Country:US
Practice Address - Phone:831-426-7322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health