Provider Demographics
NPI:1083933345
Name:INKS, BONNIE MAE (MA, LAC)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:MAE
Last Name:INKS
Suffix:
Gender:F
Credentials:MA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 THREE POND DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-9024
Mailing Address - Country:US
Mailing Address - Phone:406-375-0251
Mailing Address - Fax:406-375-0251
Practice Address - Street 1:263 THREE POND DR
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-9024
Practice Address - Country:US
Practice Address - Phone:406-375-0251
Practice Address - Fax:406-375-0251
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1306101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor