Provider Demographics
NPI:1386020907
Name:BONEN, MARK C (MHS MAC CRADC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:C
Last Name:BONEN
Suffix:
Gender:M
Credentials:MHS MAC CRADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11824 SOUTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1055
Mailing Address - Country:US
Mailing Address - Phone:847-493-3664
Mailing Address - Fax:847-493-3666
Practice Address - Street 1:11824 SOUTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1055
Practice Address - Country:US
Practice Address - Phone:847-493-3664
Practice Address - Fax:847-493-3666
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)