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General NPI Number Information
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NPI Number | 1376261677
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Entity Type | Individual
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Provider Name | PAMELA ANN BONILLA LPC-21205
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Gender | Female
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Dates
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Enumeration Date | 08/22/2022
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 3200 N. DOBSON RD. SUITE D3
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City | PHOENIX
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State | AZ
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Zip | 85014-8501
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Country | US
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Telephone | 480-420-7514
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Fax |
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Provider Business Mailing Address
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Address Line | 651 N VAL VISTA RD
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City | APACHE JUNCTION
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State | AZ
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Zip | 85119-8643
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Country | US
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Telephone | 148-081-8709
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Fax |
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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 | LPC-21205
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License Number State | AZ
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