Provider Demographics
NPI:1801952437
Name:BROWN, BONNIE LAURIE (LMHP)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:LAURIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 HOLMES PARK RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-4643
Mailing Address - Country:US
Mailing Address - Phone:308-379-3116
Mailing Address - Fax:402-682-8807
Practice Address - Street 1:2130 S 17TH ST STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3750
Practice Address - Country:US
Practice Address - Phone:308-379-3116
Practice Address - Fax:402-682-8807
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3241101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE782630000Medicaid