Stephen Richard Bunnell

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-40292 Issued in ID

Practice address

824 McCormick Rd
Weiser, ID 83672-5102

Phone

(208) 248-0477

NPI assigned

Dec 4, 2012

Last updated

Aug 28, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mellow Mountain Counseling PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Weiser, ID
  • NPI 1467171744
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1354579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661644800000",
    "number": "1225373137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 MCCORMICK RD",
            "city": "WEISER",
            "state": "ID",
            "postal_code": "836725102",
            "telephone_number": "208-248-0477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "824 MCCORMICK RD",
            "city": "WEISER",
            "state": "ID",
            "postal_code": "836725102",
            "telephone_number": "208-248-0477"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "750 N Freedom Blvd",
            "address_purpose": "LOCATION",
            "city": "Provo",
            "state": "UT",
            "postal_code": "846011677",
            "country_code": "US",
            "telephone_number": "801-373-4760",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUNNELL",
        "first_name": "STEPHEN",
        "middle_name": "RICHARD",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-12-04",
        "last_updated": "2022-08-28",
        "certification_date": "2022-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "UT",
            "license": "171560202",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW-40292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ty Curtis Bazil, PHARMD
• Bizi Ona LLC
• Jordan V Blanchard, M.D.
• Dann Henry Brugger
• Bryan L. Drake, D.O. (Family Medical Center)
• Judy Ann Carroll, MS, CCC-SLP
• Anne Louise Chennette, CNA
• Carmal Suzanne Chrisman
• Christy Marvin
• Communicare, Inc

• Clinical Social Worker in Weiser, ID
• Providers in Weiser, ID by specialty
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.