Individual
MARY BONNER
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
307 E SEVIER ST, BENTON, AR 72015-3934
(501) 315-4224
(501) 776-0411
Mailing address
307 E SEVIER ST, BENTON, AR 72015-3934
(501) 315-4224
(501) 776-0411
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
8713P
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
59275
BLUE CROSS BLUE SHIELD
AR
Enumeration date
10/04/2005
Last updated
07/08/2007
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