Healthcare Provider Details

I. General information

NPI: 1619008570
Provider Name (Legal Business Name): BONITA LOUISE KLINGINSMITH LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4384 COMMERCIAL WAY
SPRING HILL FL
34606-1965
US

IV. Provider business mailing address

4433 BAYRIDGE CT
SPRING HILL FL
34606-2014
US

V. Phone/Fax

Practice location:
  • Phone: 352-683-2362
  • Fax:
Mailing address:
  • Phone: 352-686-0370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 9034
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: