Provider Demographics
NPI:1730384975
Name:BRUCE W. BUNDY, PSYD, PC
Entity type:Organization
Organization Name:BRUCE W. BUNDY, PSYD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:BUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:541-382-0279
Mailing Address - Street 1:205 SE DAVIS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1333
Mailing Address - Country:US
Mailing Address - Phone:503-382-0279
Mailing Address - Fax:
Practice Address - Street 1:205 SE DAVIS AVE STE A
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1333
Practice Address - Country:US
Practice Address - Phone:503-382-0279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0752103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty