MEDICARE: CATHERINE BONHAM 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	101YP2500X	Professional Counselor	4822	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	IVERSON373	OTHER	CO	LPN

General Provider Information

NPI Number	:	1952606154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE BONHAM LPC

Provider Business Mailing Address
First Line	:	334 DITTMER AVE
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81004-1023
Country	:	US
Telephone Number	:	171-924-0342
Fax Number	:	719-240-3420

Provider Business Practice Location Address
First Line	:	3595 E FOUNTAIN BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-1733
Country	:	US
Telephone Number	:	719-623-2356
Fax Number	:

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

Provider Enumeration Date	:	01/19/2011
Last Update Date	:	05/30/2024

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