Provider Demographics
NPI:1609336544
Name:BUMILLER, KELLY KATHERINE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:KATHERINE
Last Name:BUMILLER
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 1:6 CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-1904
Mailing Address - Country:US
Mailing Address - Phone:207-798-9281
Mailing Address - Fax:
Practice Address - Street 1:6 CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-1904
Practice Address - Country:US
Practice Address - Phone:207-798-9281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC5235101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health