Provider Demographics
NPI:1942613427
Name:BONIFIELD, KEVIN (LPC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:BONIFIELD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8516 E 101ST ST STE E
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-7035
Mailing Address - Country:US
Mailing Address - Phone:918-900-1710
Mailing Address - Fax:918-932-1408
Practice Address - Street 1:8516 E 101ST ST STE E
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-7035
Practice Address - Country:US
Practice Address - Phone:918-900-1710
Practice Address - Fax:918-932-1408
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6072101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional