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Individual

DR. JERALD W BAMBURG JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PH.D.

Contact information

Practice address
106 N BEND DR, PINEVILLE, LA 71360-4677
(318) 442-4498
Mailing address
106 N BEND DR, PINEVILLE, LA 71360-4677
(318) 442-4498

Taxonomy

Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
951
LA
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
951
LA

Other

Enumeration date
06/20/2008
Last updated
01/11/2010
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