Healthcare Provider Details

I. General information

NPI: 1477031490
Provider Name (Legal Business Name): BONNIE ALLGOOD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 S RANGE AVE
DENHAM SPRINGS LA
70726-4806
US

IV. Provider business mailing address

924 ANGEE DR
DENHAM SPRINGS LA
70726-2602
US

V. Phone/Fax

Practice location:
  • Phone: 225-266-5034
  • Fax:
Mailing address:
  • Phone: 225-266-5034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5016
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: