Provider Demographics
NPI:1952079733
Name:BUNANSA, BA (MS, LPC, NCC, BC-TMH)
Entity Type:Individual
Prefix:
First Name:BA
Middle Name:
Last Name:BUNANSA
Suffix:
Gender:M
Credentials:MS, LPC, NCC, BC-TMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 PRESTON PARK BLVD STE 2200
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3614
Mailing Address - Country:US
Mailing Address - Phone:214-760-6963
Mailing Address - Fax:
Practice Address - Street 1:1820 PRESTON PARK BLVD STE 2200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3614
Practice Address - Country:US
Practice Address - Phone:214-760-6963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-05
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82282101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health