Provider Demographics
NPI:1568934990
Name:HAACK, BONNIE JEAN (LPC-MH)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:JEAN
Last Name:HAACK
Suffix:
Gender:F
Credentials:LPC-MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 533
Mailing Address - Street 2:
Mailing Address - City:TEA
Mailing Address - State:SD
Mailing Address - Zip Code:57064-0533
Mailing Address - Country:US
Mailing Address - Phone:605-777-1898
Mailing Address - Fax:605-777-1899
Practice Address - Street 1:125 W 1ST ST
Practice Address - Street 2:
Practice Address - City:TEA
Practice Address - State:SD
Practice Address - Zip Code:57064-3300
Practice Address - Country:US
Practice Address - Phone:605-777-1898
Practice Address - Fax:605-777-1899
Is Sole Proprietor?:No
Enumeration Date:2018-12-25
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPCMH20228101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health