Provider Demographics
NPI:1083962153
Name:BONNER, ANNETTA
Entity Type:Individual
Prefix:
First Name:ANNETTA
Middle Name:
Last Name:BONNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6330 MCLEOD DR
Mailing Address - Street 2:STE. 4 & 5
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-4430
Mailing Address - Country:US
Mailing Address - Phone:702-437-0341
Mailing Address - Fax:
Practice Address - Street 1:6330 MCLEOD DR
Practice Address - Street 2:STE. 4 & 5
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-4430
Practice Address - Country:US
Practice Address - Phone:702-437-0341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional