Provider Demographics
NPI:1659782456
Name:LACHANCE, BONNIE RENEE
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:RENEE
Last Name:LACHANCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3182 NW EXPRESSWAY
Mailing Address - Street 2:APT 407
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4157
Mailing Address - Country:US
Mailing Address - Phone:405-882-6973
Mailing Address - Fax:
Practice Address - Street 1:4130 N LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-5209
Practice Address - Country:US
Practice Address - Phone:405-651-3908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health