Provider Demographics
NPI:1669036133
Name:WATJE, BONNIE MARIE (LPC)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:MARIE
Last Name:WATJE
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 1:3342 W WAVE DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1588
Mailing Address - Country:US
Mailing Address - Phone:208-204-8490
Mailing Address - Fax:
Practice Address - Street 1:2995 N COLE RD STE 225
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5966
Practice Address - Country:US
Practice Address - Phone:208-204-8490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ID7244101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health