Healthcare Provider Details

I. General information

NPI: 1972468247
Provider Name (Legal Business Name): BONNIE JEAN VAN MEGROET INTERN, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 WALTON BLVD
ROCHESTER HILLS MI
48309-1768
US

IV. Provider business mailing address

2000 STONINGTON CT
ROCHESTER HILLS MI
48306-3262
US

V. Phone/Fax

Practice location:
  • Phone: 248-608-4514
  • Fax:
Mailing address:
  • Phone: 617-909-9545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: