Provider Demographics
NPI:1538640347
Name:BRANDON STEWART BUNKER
Entity Type:Organization
Organization Name:BRANDON STEWART BUNKER
Other - Org Name:LITTLE BUNKERS THERAPY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LCMHC
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:BUNKER
Authorized Official - Suffix:
Authorized Official - Credentials:CMHC
Authorized Official - Phone:801-655-3442
Mailing Address - Street 1:1273 N 2710 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-8287
Mailing Address - Country:US
Mailing Address - Phone:801-655-3442
Mailing Address - Fax:
Practice Address - Street 1:9055 S 1300 E STE 107
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3133
Practice Address - Country:US
Practice Address - Phone:801-655-3442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8287475-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty