Provider Demographics
NPI:1376745067
Name:BONNIE M WINKLEMAN LTD
Entity Type:Organization
Organization Name:BONNIE M WINKLEMAN LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-448-5750
Mailing Address - Street 1:2980 S RAINBOW BLVD
Mailing Address - Street 2:SUITE 210 B
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-6531
Mailing Address - Country:US
Mailing Address - Phone:702-448-5750
Mailing Address - Fax:702-448-3360
Practice Address - Street 1:2980 S RAINBOW BLVD
Practice Address - Street 2:SUITE 210 B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6531
Practice Address - Country:US
Practice Address - Phone:702-448-5750
Practice Address - Fax:702-448-3360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0405103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV37995Medicare PIN