=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750193629
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BONNIE LEE LANDAU WEED PROFESSIONAL CLINICAL COUNSELOR, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2025
-----------------------------------------------------
Last Update Date | 01/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 143 FIGUEROA ST STE 11
-----------------------------------------------------
City | VENTURA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93001-2756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-669-6106
-----------------------------------------------------
Fax | 805-710-8882
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2674 E MAIN ST STE E523
-----------------------------------------------------
City | VENTURA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93003-2820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-669-6106
-----------------------------------------------------
Fax | 805-710-8882
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. BONNIE LEE LANDAU WEED
-----------------------------------------------------
Credential | LPCC
-----------------------------------------------------
Telephone | 805-669-6106
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------