Provider Demographics
NPI:1790350130
Name:BONK, RAY (ATR-BC, MHP, LMHCA)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:
Last Name:BONK
Suffix:
Gender:M
Credentials:ATR-BC, MHP, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 NE 109TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-7749
Mailing Address - Country:US
Mailing Address - Phone:360-695-1014
Mailing Address - Fax:360-750-1374
Practice Address - Street 1:3200 NE 109TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-7749
Practice Address - Country:US
Practice Address - Phone:360-695-1014
Practice Address - Fax:360-750-1374
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61177484101YM0800X
WAMC61426504101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health