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General NPI Number Information
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NPI Number | 1669179313
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Entity Type | Individual
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Provider Name | BONNIE SUE BIXLER ACLC
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Gender | Female
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Dates
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Enumeration Date | 02/13/2023
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Last Update Date | 05/02/2023
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Provider Practice Location Address
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Address Line | 2620 CONNERY WAY
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City | MISSOULA
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State | MT
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Zip | 59808-1325
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Country | US
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Telephone | 406-203-9948
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7864
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City | MISSOULA
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State | MT
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Zip | 59807-7864
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Country | US
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Telephone | 406-203-9948
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | BBH-ACLC-LIC-44180
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License Number State | MT
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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 | BBH-PCLC-LIC-62856
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License Number State | MT
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