Provider Demographics
NPI:1396852182
Name:NELSON, BONNIE LOUISE (MA,LPC,LLP)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:LOUISE
Last Name:NELSON
Suffix:
Gender:F
Credentials:MA,LPC,LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7250 AARONWAY DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324
Mailing Address - Country:US
Mailing Address - Phone:248-560-9621
Mailing Address - Fax:
Practice Address - Street 1:28511 ORCHARD LAKE RD
Practice Address - Street 2:SUITE A
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2933
Practice Address - Country:US
Practice Address - Phone:248-489-1550
Practice Address - Fax:248-489-9767
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401002699101YP2500X
MI6301009680103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist