Provider Demographics
NPI:1336502756
Name:BONVILLAIN, BRITTNIE CRUMHOLT
Entity Type:Individual
Prefix:MRS
First Name:BRITTNIE
Middle Name:CRUMHOLT
Last Name:BONVILLAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10211 SIEGEN LN STE 2A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-4988
Mailing Address - Country:US
Mailing Address - Phone:225-769-2533
Mailing Address - Fax:
Practice Address - Street 1:10211 SIEGEN LN STE 2A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-4988
Practice Address - Country:US
Practice Address - Phone:225-769-2533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-02
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional