Provider Demographics
NPI:1851704670
Name:AMSDEN, BONNI
Entity Type:Individual
Prefix:
First Name:BONNI
Middle Name:
Last Name:AMSDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 AVENIDA LA RESOLANA NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-6103
Mailing Address - Country:US
Mailing Address - Phone:505-256-3621
Mailing Address - Fax:
Practice Address - Street 1:4011 AVENIDA LA RESOLANA NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-6103
Practice Address - Country:US
Practice Address - Phone:505-256-3621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-0166091101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health