Individual
AMANDA BUMGARNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3415 W LAKE MARY BLVD # 950103, LAKE MARY, FL 32746-3411
(407) 602-4194
Mailing address
PO BOX 950103, LAKE MARY, FL 32795-0103
(407) 602-4194
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
19847
FL
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
01/12/2021
Last updated
01/12/2021
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