Provider Demographics
NPI:1992064000
Name:BUMGARNER, JASON CHRISTIAN (LGSW)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:CHRISTIAN
Last Name:BUMGARNER
Suffix:
Gender:M
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2528 MOUNTAIN RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-7203
Mailing Address - Country:US
Mailing Address - Phone:410-255-4475
Mailing Address - Fax:
Practice Address - Street 1:2528 MOUNTAIN RD
Practice Address - Street 2:SUITE 204
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-7203
Practice Address - Country:US
Practice Address - Phone:410-255-4475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MD15025104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health