Provider Demographics
NPI:1033289277
Name:BONHOMIE COUNSELING CORP
Entity Type:Organization
Organization Name:BONHOMIE COUNSELING CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:C
Authorized Official - Middle Name:JOANN
Authorized Official - Last Name:BEATHEA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:574-293-5991
Mailing Address - Street 1:330 W LEXINGTON AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516
Mailing Address - Country:US
Mailing Address - Phone:574-293-5991
Mailing Address - Fax:574-293-5429
Practice Address - Street 1:330 W LEXINGTON AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516
Practice Address - Country:US
Practice Address - Phone:574-293-5991
Practice Address - Fax:574-293-5429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN179650Medicare ID - Type Unspecified