Provider Demographics
NPI:1437264165
Name:PERRY, BONITA DAWN (LPCC)
Entity Type:Individual
Prefix:
First Name:BONITA
Middle Name:DAWN
Last Name:PERRY
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 S SAINT FRANCIS DR STE E
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4053
Mailing Address - Country:US
Mailing Address - Phone:505-577-4273
Mailing Address - Fax:
Practice Address - Street 1:1223 S SAINT FRANCIS DR STE E
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4053
Practice Address - Country:US
Practice Address - Phone:505-982-8098
Practice Address - Fax:505-982-3948
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2022-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0115291101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health