Provider Demographics
NPI:1497165302
Name:BOUKNIGHT, BERNADINE
Entity Type:Individual
Prefix:
First Name:BERNADINE
Middle Name:
Last Name:BOUKNIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1050 E CACTUS AVE
Mailing Address - Street 2:1042
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-7364
Mailing Address - Country:US
Mailing Address - Phone:804-721-6919
Mailing Address - Fax:
Practice Address - Street 1:1050 E CACTUS AVE
Practice Address - Street 2:1042
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-7364
Practice Address - Country:US
Practice Address - Phone:804-721-6919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health