Provider Demographics
NPI:1740265990
Name:BONNER, LAUREN T (MD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:T
Last Name:BONNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:T
Other - Last Name:BONNER LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2806 W AMBERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85045-4210
Mailing Address - Country:US
Mailing Address - Phone:602-525-0610
Mailing Address - Fax:
Practice Address - Street 1:STRATEGIC MENTAL HEALTH
Practice Address - Street 2:8160 E BUTHERUS
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2671
Practice Address - Country:US
Practice Address - Phone:602-377-7326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04320132084P0800X
NM98172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H88447Medicare UPIN