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General NPI Number Information
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NPI Number | 1184833881
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Entity Type | Individual
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Provider Name | BONNIE KAY MARKS LMFT
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Gender | Female
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 09/24/2009
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Provider Practice Location Address
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Address Line | 1115 N GRAND AVE SUITE 201
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City | PUEBLO
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State | CO
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Zip | 81003-2867
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Country | US
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Telephone | 719-544-1404
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Fax | 719-544-1404
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Provider Business Mailing Address
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Address Line | 1814 AQUILA DR
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City | PUEBLO
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State | CO
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Zip | 81008-2617
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Country | US
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Telephone | 719-924-8266
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Fax | 719-924-8266
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT140
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 890
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC36793
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License Number State | CA
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