Provider Demographics
NPI:1407855570
Name:CAMPBELL, BONNIE MARIE (LMFT, LMHC, CAP, SAP)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:MARIE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LMFT, LMHC, CAP, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 HAYS ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-2632
Mailing Address - Country:US
Mailing Address - Phone:850-559-6082
Mailing Address - Fax:850-765-4269
Practice Address - Street 1:1102 HAYS ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-2632
Practice Address - Country:US
Practice Address - Phone:850-559-6082
Practice Address - Fax:850-765-4269
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2187101YA0400X
FL5993101YM0800X
FL2049106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008598700Medicaid