Provider Demographics
NPI:1366616443
Name:BUNCH, THEODORE JAMES (LPC)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:JAMES
Last Name:BUNCH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10360 DRUMMOND ROAD
Mailing Address - Street 2:BELMONT CENTER
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19154
Mailing Address - Country:US
Mailing Address - Phone:215-632-6400
Mailing Address - Fax:215-581-3827
Practice Address - Street 1:10360 DRUMMOND ROAD
Practice Address - Street 2:BELMONT CENTER
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19154
Practice Address - Country:US
Practice Address - Phone:215-632-6400
Practice Address - Fax:215-581-3827
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004824101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional