Provider Demographics
NPI:1710054416
Name:MATHESON, BONNIE N (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:N
Last Name:MATHESON
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 1:38091 N 4000 RD
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:OK
Mailing Address - Zip Code:74061-2537
Mailing Address - Country:US
Mailing Address - Phone:918-371-5609
Mailing Address - Fax:
Practice Address - Street 1:2200 SE WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-7135
Practice Address - Country:US
Practice Address - Phone:918-335-1111
Practice Address - Fax:918-335-1119
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3583101YP2500X
LA2742101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional