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NPI Code Detail

MEDICARE: SARAH KATRINA BONNEY

MEDICARE: SARAH KATRINA BONNEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorT-CTL0206651NM

General Provider Information

NPI Number : 1780226902
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH KATRINA BONNEY
Provider Business Mailing Address
First Line : 2528 RIDGE RUNNER RD
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-4971
Country : US
Telephone Number : 505-429-6029
Fax Number :
Provider Business Practice Location Address
First Line : 2528 RIDGE RUNNER RD
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-4971
Country : US
Telephone Number : 505-429-6029
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2019
Last Update Date : 10/09/2019

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