Provider Demographics
NPI:1841855103
Name:WILLIAM GUY BONIFACE LPC
Entity type:Organization
Organization Name:WILLIAM GUY BONIFACE LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPISTS
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BONIFACE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:719-398-1544
Mailing Address - Street 1:8655 PEPPERRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-5739
Mailing Address - Country:US
Mailing Address - Phone:719-398-1544
Mailing Address - Fax:
Practice Address - Street 1:1401 POTTER DR STE 101
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-3500
Practice Address - Country:US
Practice Address - Phone:719-398-1544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO968868Medicaid