Provider Demographics
NPI:1295179588
Name:HOTZ, BONNIE L (MED, LPC)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:L
Last Name:HOTZ
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 ZERO AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-4925
Mailing Address - Country:US
Mailing Address - Phone:636-221-8012
Mailing Address - Fax:
Practice Address - Street 1:1703 ZERO AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-4925
Practice Address - Country:US
Practice Address - Phone:636-221-8012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011008115101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional