Individual
LAURA A. BUMBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
1129 MACKLIND AVE, SAINT LOUIS, MO 63110-1440
(314) 534-0200
(314) 534-7996
Mailing address
1129 MACKLIND AVE, SAINT LOUIS, MO 63110-1440
(314) 534-0200
(314) 534-7996
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2009034694
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23-2812942
ST. LOUIS BEHAVIORAL MEDICINE INSTITUTE
MO
Enumeration date
05/18/2007
Last updated
01/12/2010
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