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General NPI Number Information
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NPI Number | 1013356609
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Entity Type | Individual
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Provider Name | BONNIE D WEBSTER MS
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Gender | Female
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Dates
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Enumeration Date | 06/18/2013
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Last Update Date | 07/29/2020
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Provider Practice Location Address
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Address Line | 222 W BROADWAY
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City | MOUNTAINAIR
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State | NM
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Zip | 87036
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Country | US
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Telephone | 505-847-2320
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Fax | 505-847-2995
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Provider Business Mailing Address
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Address Line | 2960 RODEO PARK DR. W
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City | SANTA FE
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State | NM
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Zip | 87505
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Country | US
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Telephone | 505-986-9633
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Fax | 505-473-3038
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | T-CTL0212501
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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