Organization
BON CREATIVE CHANGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BONNIE J BOUCHER LPCC (OWNER/DIRECTOR)
(505) 620-9785
Entity
Organization
Contact information
Practice address
1400 BARBARA LOOP SE STE H, RIO RANCHO, NM 87124-1088
(505) 620-9785
Mailing address
11024 MONTGOMERY BLVD NE # 359, ALBUQUERQUE, NM 87111-3962
(505) 620-9785
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0124121
NM
101YP2500X
Professional Counselor
O124121
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0124121
LPCC LICENSE
NM
Enumeration date
11/04/2017
Last updated
01/24/2018
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