Provider Demographics
NPI:1174842264
Name:SLATER, BONNIE (LPC)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:SLATER
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 1:7047 E GREENWAY PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-8113
Mailing Address - Country:US
Mailing Address - Phone:480-322-0278
Mailing Address - Fax:602-870-7472
Practice Address - Street 1:7047 E GREENWAY PKWY STE 250
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-8113
Practice Address - Country:US
Practice Address - Phone:480-322-0278
Practice Address - Fax:602-870-7472
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2281558385HR2055X
AZLPC11789101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child