Provider Demographics
NPI:1760790331
Name:DEOPP, BONNIE TOLLEFSON (LMHC, CN)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:TOLLEFSON
Last Name:DEOPP
Suffix:
Gender:F
Credentials:LMHC, CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 NE 65TH ST UNIT 506
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5671
Mailing Address - Country:US
Mailing Address - Phone:206-657-4242
Mailing Address - Fax:
Practice Address - Street 1:900 NE 65TH ST UNIT 506
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115
Practice Address - Country:US
Practice Address - Phone:206-657-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19170101YM0800X
WA61170457133N00000X
WA61182113101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No133N00000XDietary & Nutritional Service ProvidersNutritionist