Provider Demographics
NPI:1922254655
Name:TOKOPH, BONNIE ELIZABETH (LISAC, MC)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:ELIZABETH
Last Name:TOKOPH
Suffix:
Gender:F
Credentials:LISAC, MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 E HELENA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-2077
Mailing Address - Country:US
Mailing Address - Phone:602-527-8600
Mailing Address - Fax:602-971-2494
Practice Address - Street 1:18001 N 79TH AVE STE C53
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8394
Practice Address - Country:US
Practice Address - Phone:602-527-8600
Practice Address - Fax:602-971-2494
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11717101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional