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General NPI Number Information
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NPI Number | 1851884167
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Entity Type | Individual
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Provider Name | BEVERLY JEAN BONNELL LPCC
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Gender | Female
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Dates
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Enumeration Date | 06/11/2018
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Last Update Date | 08/09/2021
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Provider Practice Location Address
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Address Line | 707 BROADWAY BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-2360
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Country | US
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Telephone | 505-345-8471
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Fax | 505-342-5414
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Provider Business Mailing Address
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Address Line | 1995 ASH ST SW
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City | DEMING
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State | NM
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Zip | 88030-0793
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Country | US
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Telephone | 330-205-5675
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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 | CCMH0218971
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E.1700338
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License Number State | OH
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