Individual
GREGORY BONVILLIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
350 MAIN ST, BAKER, LA 70714-3767
(225) 778-6783
(225) 612-6602
Mailing address
11349 COPPERWOOD DR, DENHAM SPRINGS, LA 70726-6087
(225) 892-0103
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
LA
Other
Enumeration date
11/16/2017
Last updated
06/16/2018
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