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Individual

MRS. BEVERLY JEAN BONNELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LPCC

Contact information

Practice address
707 BROADWAY BLVD NE, ALBUQUERQUE, NM 87102-2360
(505) 345-8471
(505) 342-5414
Mailing address
1995 ASH ST SW, DEMING, NM 88030-0793
(330) 205-5675

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
CCMH0218971
NM
101YP2500X
Professional Counselor
E.1700338
OH

Other

Enumeration date
06/11/2018
Last updated
08/09/2021
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