Provider Demographics
NPI:1073977070
Name:DEN DOOVEN, BONNIE ANN (MC, LPC, CSAT)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:ANN
Last Name:DEN DOOVEN
Suffix:
Gender:F
Credentials:MC, LPC, CSAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50825 N 328TH AVE
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-3107
Mailing Address - Country:US
Mailing Address - Phone:928-231-2411
Mailing Address - Fax:
Practice Address - Street 1:15331 W BELL RD STE 212
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-4104
Practice Address - Country:US
Practice Address - Phone:928-231-2411
Practice Address - Fax:928-231-2411
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-15443101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional