Provider Demographics
NPI:1457471294
Name:SHEVOCK, BONNIE LYNNE (LPC)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:LYNNE
Last Name:SHEVOCK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 CARBON CENTER ROAD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16002
Mailing Address - Country:US
Mailing Address - Phone:724-282-8276
Mailing Address - Fax:
Practice Address - Street 1:201 EAST JEFFERSON ST
Practice Address - Street 2:SAMARITAN COUNSELING CENTER
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001
Practice Address - Country:US
Practice Address - Phone:724-287-2567
Practice Address - Fax:412-741-7430
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002930101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1465775OtherHIGHMARK BLUE CROSS BLUE
PA11634100OtherCAQH UNITED BEHAVIORAL HE