Provider Demographics
NPI:1124850987
Name:BYNUM LICENSED CLINICAL SOCIAL WORK INC.
Entity type:Organization
Organization Name:BYNUM LICENSED CLINICAL SOCIAL WORK INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISSY
Authorized Official - Middle Name:
Authorized Official - Last Name:BYNUM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:661-473-0090
Mailing Address - Street 1:110 S MONTCLAIR ST STE 106
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-3118
Mailing Address - Country:US
Mailing Address - Phone:661-473-0090
Mailing Address - Fax:661-735-0109
Practice Address - Street 1:110 S MONTCLAIR ST STE 106
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-3118
Practice Address - Country:US
Practice Address - Phone:661-473-0090
Practice Address - Fax:661-735-0109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty