MEDICARE: BONNIE KIEFEL LCDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	11743	TX

General Provider Information

NPI Number	:	1437500337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE KIEFEL LCDC

Provider Business Mailing Address
First Line	:	75 LAKEWOOD CIR
Second Line	:
City	:	LAKE DALLAS
State	:	TX
Zip	:	75065-3117
Country	:	US
Telephone Number	:	214-929-9169
Fax Number	:

Provider Business Practice Location Address
First Line	:	75 LAKEWOOD CIR
Second Line	:
City	:	LAKE DALLAS
State	:	TX
Zip	:	75065-3117
Country	:	US
Telephone Number	:	214-929-9169
Fax Number	:

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

Provider Enumeration Date	:	06/22/2016
Last Update Date	:	06/22/2016

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Directions to “ BONNIE KIEFEL LCDC” Practice Location

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