Provider Demographics
NPI:1336736156
Name:HANA BUMP, SUSAN LEIGH
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LEIGH
Last Name:HANA BUMP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 W 5TH ST STE 308
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-2750
Mailing Address - Country:US
Mailing Address - Phone:424-570-6955
Mailing Address - Fax:
Practice Address - Street 1:302 W 5TH ST STE 308
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-2750
Practice Address - Country:US
Practice Address - Phone:424-570-6955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA114976106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist