Provider Demographics
NPI:1730309378
Name:BUNDY, SHARLA (LCSW)
Entity Type:Individual
Prefix:
First Name:SHARLA
Middle Name:
Last Name:BUNDY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 RUFE SNOW DR
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-6163
Mailing Address - Country:US
Mailing Address - Phone:817-428-1441
Mailing Address - Fax:817-428-3327
Practice Address - Street 1:5750 RUFE SNOW DR
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-6163
Practice Address - Country:US
Practice Address - Phone:817-428-1441
Practice Address - Fax:817-428-3327
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170736601Medicaid