Provider Demographics
NPI:1235824707
Name:STICE, BONNIE (MA, LPC ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:STICE
Suffix:
Gender:F
Credentials:MA, LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 E HICKORY ST APT 222
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-4313
Mailing Address - Country:US
Mailing Address - Phone:940-290-0762
Mailing Address - Fax:
Practice Address - Street 1:612 E HICKORY ST APT 222
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-4313
Practice Address - Country:US
Practice Address - Phone:940-290-0762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86302101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional