Individual
BLAINE ALAN BONNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
5903 STOCKWOOD ST, BOSSIER CITY, LA 71111-5607
(318) 510-7034
Mailing address
5903 STOCKWOOD ST, BOSSIER CITY, LA 71111-5607
(318) 510-7034
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
5858
LA
Other
Enumeration date
12/17/2015
Last updated
12/17/2015
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