Provider Demographics
NPI:1841439940
Name:BUMGARNER, DENNIS MICHAEL (LCSW)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:MICHAEL
Last Name:BUMGARNER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8311 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-1808
Mailing Address - Country:US
Mailing Address - Phone:317-271-8700
Mailing Address - Fax:317-271-8790
Practice Address - Street 1:8311 W 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46234-1808
Practice Address - Country:US
Practice Address - Phone:317-271-8700
Practice Address - Fax:317-271-8790
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000592A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical