Provider Demographics
NPI:1902156227
Name:BUNN, CHRISTOPHER SHANE (MS, RASAC II)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:SHANE
Last Name:BUNN
Suffix:
Gender:M
Credentials:MS, RASAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 S ELLIOTT AVE
Mailing Address - Street 2:P.O. BOX 1027
Mailing Address - City:AURORA
Mailing Address - State:MO
Mailing Address - Zip Code:65605-2103
Mailing Address - Country:US
Mailing Address - Phone:417-671-9856
Mailing Address - Fax:417-671-9881
Practice Address - Street 1:1401 S ELLIOTT AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:MO
Practice Address - Zip Code:65605-2103
Practice Address - Country:US
Practice Address - Phone:417-671-9856
Practice Address - Fax:417-671-9881
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013002404101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional