Provider Demographics
NPI:1699829796
Name:HUESTIS, BONNIE (LCPC)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:HUESTIS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 9TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-5712
Mailing Address - Country:US
Mailing Address - Phone:406-453-6006
Mailing Address - Fax:406-452-5320
Practice Address - Street 1:5200 9TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5712
Practice Address - Country:US
Practice Address - Phone:406-453-6006
Practice Address - Fax:406-452-5320
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT310 LCPC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0251447Medicaid
MT75108OtherBCBS PROVIDER NUMBER