Provider Demographics
NPI:1326438698
Name:BUNNELL, REX (MLADC)
Entity Type:Individual
Prefix:
First Name:REX
Middle Name:
Last Name:BUNNELL
Suffix:
Gender:M
Credentials:MLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 645
Mailing Address - Street 2:
Mailing Address - City:WOLFEBORO FALLS
Mailing Address - State:NH
Mailing Address - Zip Code:03896-0645
Mailing Address - Country:US
Mailing Address - Phone:603-387-9693
Mailing Address - Fax:
Practice Address - Street 1:379 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894-4437
Practice Address - Country:US
Practice Address - Phone:603-387-9693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0873101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)