Provider Demographics
NPI:1639750631
Name:BONILLA, ALESSANDRA (MS, LPC)
Entity Type:Individual
Prefix:
First Name:ALESSANDRA
Middle Name:
Last Name:BONILLA
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 EXECUTIVE DR APT 5308
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-0263
Mailing Address - Country:US
Mailing Address - Phone:786-340-9693
Mailing Address - Fax:
Practice Address - Street 1:1515 HERITAGE DR STE 105
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-3378
Practice Address - Country:US
Practice Address - Phone:469-963-3561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85717101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health