Provider Demographics
NPI:1245865468
Name:CATANACH, BONNIE MARIE
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:MARIE
Last Name:CATANACH
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 1:3136 JEMEZ RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-8004
Mailing Address - Country:US
Mailing Address - Phone:505-603-1353
Mailing Address - Fax:
Practice Address - Street 1:3136 JEMEZ RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-8004
Practice Address - Country:US
Practice Address - Phone:505-603-1353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCSA0210251101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)