Provider Demographics
NPI:1447773411
Name:BONTRAGER, CRISSY (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:CRISSY
Middle Name:
Last Name:BONTRAGER
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 1:6047 FRANTZ RD STE 105
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3365
Mailing Address - Country:US
Mailing Address - Phone:614-336-7856
Mailing Address - Fax:614-336-7857
Practice Address - Street 1:6047 FRANTZ RD STE 105
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3365
Practice Address - Country:US
Practice Address - Phone:614-336-7856
Practice Address - Fax:614-336-7857
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2001831101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional