MEDICARE: VICKI LYNNE BONHAM 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	21277	FL

General Provider Information

NPI Number	:	1881316776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKI LYNNE BONHAM LMHC

Provider Business Mailing Address
First Line	:	618 SW 3RD ST STE 110
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-1995
Country	:	US
Telephone Number	:	239-826-3655
Fax Number	:

Provider Business Practice Location Address
First Line	:	618 SW 3RD ST STE 110
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-1995
Country	:	US
Telephone Number	:	239-940-7025
Fax Number	:

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

Provider Enumeration Date	:	09/16/2022
Last Update Date	:	03/11/2026

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