Provider Demographics
NPI:1619602158
Name:BONESIO-SIMPSON, JO KRISTIN (LPC)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:KRISTIN
Last Name:BONESIO-SIMPSON
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 1:9551 ASH CREEK DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-3734
Mailing Address - Country:US
Mailing Address - Phone:214-215-9337
Mailing Address - Fax:
Practice Address - Street 1:9551 ASH CREEK DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-3734
Practice Address - Country:US
Practice Address - Phone:214-215-9337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77303101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health