Provider Demographics
NPI:1669179313
Name:BIXLER, BONNIE SUE (ACLC)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:SUE
Last Name:BIXLER
Suffix:
Gender:F
Credentials:ACLC
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7864
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59807-7864
Mailing Address - Country:US
Mailing Address - Phone:406-203-9948
Mailing Address - Fax:
Practice Address - Street 1:2620 CONNERY WAY
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1325
Practice Address - Country:US
Practice Address - Phone:406-203-9948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-ACLC-LIC-44180101YA0400X
MTBBH-PCLC-LIC-62856101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)