Provider Demographics
NPI:1255129078
Name:BUNKER, DONOVAN (ACMHC)
Entity type:Individual
Prefix:
First Name:DONOVAN
Middle Name:
Last Name:BUNKER
Suffix:
Gender:
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 N 1000 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-2551
Mailing Address - Country:US
Mailing Address - Phone:801-362-2435
Mailing Address - Fax:
Practice Address - Street 1:1250 E 200 S STE 1A
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-1470
Practice Address - Country:US
Practice Address - Phone:385-223-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13724034-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health