MEDICARE: MS. BONITA LOUISE KLINGINSMITH LMHC

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	MH 9034	FL

General Provider Information

NPI Number	:	1619008570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BONITA LOUISE KLINGINSMITH LMHC

Provider Business Mailing Address
First Line	:	4433 BAYRIDGE CT
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34606-2014
Country	:	US
Telephone Number	:	352-686-0370
Fax Number	:

Provider Business Practice Location Address
First Line	:	4384 COMMERCIAL WAY
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34606-1965
Country	:	US
Telephone Number	:	352-683-2362
Fax Number	:

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/08/2007

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