Provider Demographics
NPI:1376261677
Name:BONILLA, PAMELA ANN (LPC-21205)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ANN
Last Name:BONILLA
Suffix:
Gender:F
Credentials:LPC-21205
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 N VAL VISTA RD
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85119-8643
Mailing Address - Country:US
Mailing Address - Phone:148-081-8709
Mailing Address - Fax:
Practice Address - Street 1:3200 N. DOBSON RD.
Practice Address - Street 2:SUITE D3
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-8501
Practice Address - Country:US
Practice Address - Phone:480-420-7514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-21205101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional