Provider Demographics
NPI:1801923339
Name:BROWN, BONNIE MARIE
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:MARIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:BONNIE
Other - Middle Name:MARIE
Other - Last Name:WINKLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2780 S JONES BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5628
Mailing Address - Country:US
Mailing Address - Phone:888-320-2271
Mailing Address - Fax:888-765-5221
Practice Address - Street 1:1675 E MT GARFIELD RD STE 135
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-7732
Practice Address - Country:US
Practice Address - Phone:231-799-8880
Practice Address - Fax:231-799-8803
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0405103TC0700X, 103TC1900X
MI6301017020103TC1900X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1801923339Medicaid
NV002602083Medicaid
GZ355AMedicare UPIN