Provider Demographics
NPI:1023707288
Name:GROSSMAN, BONNIE D (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:D
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:D
Other - Last Name:GROSSMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:5102 E RAMADA DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-5982
Mailing Address - Country:US
Mailing Address - Phone:928-533-5173
Mailing Address - Fax:
Practice Address - Street 1:505 WHIPPLE ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1747
Practice Address - Country:US
Practice Address - Phone:928-308-9050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC21349101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional