Provider Demographics
NPI:1508032368
Name:BONNER, KAREN MORI (LPC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MORI
Last Name:BONNER
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 1:529 S PEAR ORCHARD RD STE D
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4235
Mailing Address - Country:US
Mailing Address - Phone:601-594-1961
Mailing Address - Fax:
Practice Address - Street 1:529 S PEAR ORCHARD RD STE D
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4235
Practice Address - Country:US
Practice Address - Phone:601-594-1961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1293101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional