Healthcare Provider Details

I. General information

NPI: 1083933345
Provider Name (Legal Business Name): BONNIE MAE INKS MA, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 THREE POND DR
HAMILTON MT
59840-9024
US

IV. Provider business mailing address

263 THREE POND DR
HAMILTON MT
59840-9024
US

V. Phone/Fax

Practice location:
  • Phone: 406-375-0251
  • Fax: 406-375-0251
Mailing address:
  • Phone: 406-375-0251
  • Fax: 406-375-0251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-LAC-LIC-1306
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBBH-LCPC-LIC-33663
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: