Provider Demographics
NPI:1487972022
Name:BUNCH, SHAURI (LPC)
Entity type:Individual
Prefix:
First Name:SHAURI
Middle Name:
Last Name:BUNCH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1942 NW KEARNEY ST STE 30
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1465
Mailing Address - Country:US
Mailing Address - Phone:503-701-2903
Mailing Address - Fax:
Practice Address - Street 1:1942 NW KEARNEY ST STE 30
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1465
Practice Address - Country:US
Practice Address - Phone:503-701-2903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2001101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional