MEDICARE: STEPHEN ANTHONY BONNETTE MS LPC

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	72435	TX

General Provider Information

NPI Number	:	1568190866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN ANTHONY BONNETTE MS LPC

Provider Business Mailing Address
First Line	:	3706 SUNRISE DR
Second Line	:
City	:	LA PORTE
State	:	TX
Zip	:	77571-7376
Country	:	US
Telephone Number	:	337-591-2245
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 NASA PKWY STE 545T
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3358
Country	:	US
Telephone Number	:	832-304-3246
Fax Number	:

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

Provider Enumeration Date	:	08/13/2022
Last Update Date	:	08/13/2022

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