Provider Demographics
NPI:1922146083
Name:RABE, BONNIE JEANNE (MC, LPC)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:JEANNE
Last Name:RABE
Suffix:
Gender:F
Credentials:MC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 W CAROLINE LN
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3021
Mailing Address - Country:US
Mailing Address - Phone:480-839-6814
Mailing Address - Fax:
Practice Address - Street 1:1250 E BASELINE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1404
Practice Address - Country:US
Practice Address - Phone:480-753-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-11856101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPC-11856OtherLICENSE NUMBER
AZ896805Medicaid