Provider Demographics
NPI:1376641803
Name:BLANZY, BONNIE SUE (MA LPC)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:SUE
Last Name:BLANZY
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:SUE
Other - Last Name:BUHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA LPC
Mailing Address - Street 1:12850 FOUNTAIN SQ.
Mailing Address - Street 2:STE. 106
Mailing Address - City:DAVISBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48350
Mailing Address - Country:US
Mailing Address - Phone:248-634-6303
Mailing Address - Fax:248-634-1746
Practice Address - Street 1:12850 FOUNTAIN SQ.
Practice Address - Street 2:STE. 106
Practice Address - City:DAVISBURG
Practice Address - State:MI
Practice Address - Zip Code:48350
Practice Address - Country:US
Practice Address - Phone:248-634-6303
Practice Address - Fax:248-634-1746
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007985101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health