Provider Demographics
NPI:1265952451
Name:TEMPLE, BONNIE THIELKE (MA, NCC)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:THIELKE
Last Name:TEMPLE
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 51ST ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-6025
Mailing Address - Country:US
Mailing Address - Phone:541-556-7681
Mailing Address - Fax:
Practice Address - Street 1:921 COUNTRY CLUB RD STE 222
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2238
Practice Address - Country:US
Practice Address - Phone:541-686-6000
Practice Address - Fax:541-344-8239
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR4797101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health