Healthcare Provider Details

I. General information

NPI: 1992292981
Provider Name (Legal Business Name): BONNIE KATHRYN SPICER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 BELLMEADE DRIVE
JACKSON TN
38301-2202
US

IV. Provider business mailing address

165 BELLMEADE DR
JACKSON TN
38301-7854
US

V. Phone/Fax

Practice location:
  • Phone: 731-803-1447
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5957
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5957
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: