Individual
BONNIE ROSE BURY-BLATTMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
2808 S MAIN ST STE I, LINDALE, TX 75771-7854
(903) 565-9022
(214) 224-0731
Mailing address
10116 SPARKS DR, TYLER, TX 75704-3935
(903) 565-9022
(214) 224-0731
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
11745
TX
101YP2500X
Professional Counselor
Primary
80342
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
396545103
—
TX
Enumeration date
02/09/2019
Last updated
04/08/2026
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