MEDICARE: BONITA DAWN PERRY LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0115291	NM

General Provider Information

NPI Number	:	1437264165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONITA DAWN PERRY LPCC

Provider Business Mailing Address
First Line	:	1223 S SAINT FRANCIS DR STE E
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-4053
Country	:	US
Telephone Number	:	505-577-4273
Fax Number	:

Provider Business Practice Location Address
First Line	:	1223 S SAINT FRANCIS DR STE E
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-4053
Country	:	US
Telephone Number	:	505-982-8098
Fax Number	:	505-982-3948

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	08/21/2022

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