Provider Demographics
NPI:1376045583
Name:BUNTON, BRITTANY ANNE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:BRITTANY
Middle Name:ANNE
Last Name:BUNTON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5702 ELAINE DR. SUITE 106
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2458
Mailing Address - Country:US
Mailing Address - Phone:815-904-2188
Mailing Address - Fax:815-277-1246
Practice Address - Street 1:5702 ELAINE DR. SUITE 106
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2458
Practice Address - Country:US
Practice Address - Phone:815-904-2188
Practice Address - Fax:815-277-1246
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-03
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178012309101YM0800X
IL180011507101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health