Provider Demographics
NPI:1639519234
Name:WILSON, BRITTANY BUNDY (LPCC-S)
Entity Type:Individual
Prefix:MISS
First Name:BRITTANY
Middle Name:BUNDY
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:JANNA
Other - Last Name:BUNDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:108 FERN HILL DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9759
Mailing Address - Country:US
Mailing Address - Phone:606-682-0025
Mailing Address - Fax:
Practice Address - Street 1:4885 HOUSTON RD STE 200
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4894
Practice Address - Country:US
Practice Address - Phone:606-682-0025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1224101YM0800X
KY104084101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health