Provider Demographics
NPI:1104854736
Name:WARD, BONNIE M (LPC)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:M
Last Name:WARD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1589
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74502-1589
Mailing Address - Country:US
Mailing Address - Phone:918-423-3700
Mailing Address - Fax:918-423-3712
Practice Address - Street 1:100 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5364
Practice Address - Country:US
Practice Address - Phone:918-423-3700
Practice Address - Fax:918-423-3712
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2380101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional