Provider Demographics
NPI:1801025507
Name:SUSAN FORDE-BUNCH PC
Entity Type:Organization
Organization Name:SUSAN FORDE-BUNCH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FORDE-BUNCH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:303-431-5641
Mailing Address - Street 1:5460 WARD RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-1825
Mailing Address - Country:US
Mailing Address - Phone:303-431-5641
Mailing Address - Fax:303-467-1145
Practice Address - Street 1:5460 WARD RD
Practice Address - Street 2:SUITE 210
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-1825
Practice Address - Country:US
Practice Address - Phone:303-431-5641
Practice Address - Fax:303-467-1145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLCSW 9850581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1508910043OtherINDIVIDUAL NPI