Individual
BONNIE JEAN EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
111 BIG SKY AVE SW, LOS LUNAS, NM 87031-6155
(505) 865-9026
Mailing address
01 SAGEBRUSH ST, ISLETA, NM 87022-0000
(505) 869-5479
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0097631
NM
101YM0800X
Mental Health Counselor
Primary
CCMH0104231
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0097631
LICENSE
NM
Enumeration date
01/03/2014
Last updated
01/12/2021
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