Individual
SHELLEY F BONIELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
610 MAIN ST, LAFAYETTE, IN 47901-1451
(765) 423-2638
Mailing address
610 MAIN ST, LAFAYETTE, IN 47901-1451
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
87000765A
IN
101YM0800X
Mental Health Counselor
Primary
39001692A
IN
Other
Enumeration date
06/28/2011
Last updated
06/28/2011
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