Provider Demographics
NPI:1134811987
Name:BONNER, CAROLE ELAINE
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:ELAINE
Last Name:BONNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 E LA SALLE ST STE 222
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-2359
Mailing Address - Country:US
Mailing Address - Phone:719-271-4115
Mailing Address - Fax:
Practice Address - Street 1:2210 E LA SALLE ST STE 222
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2359
Practice Address - Country:US
Practice Address - Phone:719-271-4115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor