Provider Demographics
NPI:1235124116
Name:BUTCHER, BONNIE (LMHC)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:BUTCHER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E MIRACLE STRIP PKWY
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569-1988
Mailing Address - Country:US
Mailing Address - Phone:850-243-8086
Mailing Address - Fax:850-243-2702
Practice Address - Street 1:124 E MIRACLE STRIP PKWY
Practice Address - Street 2:SUITE 302
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-1988
Practice Address - Country:US
Practice Address - Phone:850-243-8086
Practice Address - Fax:850-243-2702
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH1908101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health