Healthcare Provider Details

I. General information

NPI: 1508640053
Provider Name (Legal Business Name): BONFIRE HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6877 OLD GUIDE RD
LYNDEN WA
98264-9631
US

IV. Provider business mailing address

4500 9TH AVE NE STE 300
SEATTLE WA
98105-4762
US

V. Phone/Fax

Practice location:
  • Phone: 425-835-2578
  • Fax:
Mailing address:
  • Phone: 206-657-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name: BONNIE DEOPP
Title or Position: OWNER
Credential: LMHC, CN
Phone: 206-657-4242