Provider Demographics
NPI:1982179545
Name:NYTES, BONNIE BROD (LCPC)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:BROD
Last Name:NYTES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 S 8TH ST STE N
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4159
Mailing Address - Country:US
Mailing Address - Phone:217-617-5133
Mailing Address - Fax:
Practice Address - Street 1:325 S 8TH ST STE N
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4159
Practice Address - Country:US
Practice Address - Phone:217-617-5133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.013007101YM0800X
IL178.013806101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional