=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437435237
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNN BONNER-NELSON LMHC, CRC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2011
-----------------------------------------------------
Last Update Date | 05/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6161 DR. MLK JR STREET N. #204
-----------------------------------------------------
City | SAINT PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-520-9447
-----------------------------------------------------
Fax | 727-520-9444
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6161 DR. MLK JR STREET N. #204
-----------------------------------------------------
City | SAINT PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-520-9447
-----------------------------------------------------
Fax | 727-520-9444
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH7780
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------