Provider Demographics
NPI:1881195972
Name:BONIN, MINERVA (LPC)
Entity Type:Individual
Prefix:
First Name:MINERVA
Middle Name:
Last Name:BONIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 81ST ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-2326
Mailing Address - Country:US
Mailing Address - Phone:806-781-6143
Mailing Address - Fax:
Practice Address - Street 1:4630 50TH ST STE 412
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-3519
Practice Address - Country:US
Practice Address - Phone:806-781-6143
Practice Address - Fax:806-300-0235
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75212101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional