Provider Demographics
NPI:1376962126
Name:BUNBURY, AIMEE LOUISE (LMSW)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:LOUISE
Last Name:BUNBURY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 E WATER VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LAKE LEELANAU
Mailing Address - State:MI
Mailing Address - Zip Code:49653-8420
Mailing Address - Country:US
Mailing Address - Phone:231-632-4974
Mailing Address - Fax:
Practice Address - Street 1:105 HALL ST UNIT A
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2288
Practice Address - Country:US
Practice Address - Phone:231-590-5068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010973351041C0700X
MI68011091591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical