Provider Demographics
NPI:1851884167
Name:BONNELL, BEVERLY JEAN (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:JEAN
Last Name:BONNELL
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 ASH ST SW
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-0793
Mailing Address - Country:US
Mailing Address - Phone:330-205-5675
Mailing Address - Fax:
Practice Address - Street 1:707 BROADWAY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2360
Practice Address - Country:US
Practice Address - Phone:505-345-8471
Practice Address - Fax:505-342-5414
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0218971101YP2500X
OHE.1700338101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional