Provider Demographics
NPI:1659938611
Name:O'BOYLE, BONNIE DENISE (LPC)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:DENISE
Last Name:O'BOYLE
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 1:908 S WALTON BLVD STE 39
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-6287
Mailing Address - Country:US
Mailing Address - Phone:479-225-6027
Mailing Address - Fax:844-316-3842
Practice Address - Street 1:908 S WALTON BLVD STE 39
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-6287
Practice Address - Country:US
Practice Address - Phone:479-225-6027
Practice Address - Fax:844-316-3842
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-24
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1905053101YP2500X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR235944795Medicaid