Provider Demographics
NPI:1730347717
Name:STEPHENS, BONNIE DENISE (MED LPC)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:DENISE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5037 FM 256 E
Mailing Address - Street 2:
Mailing Address - City:COLMESNEIL
Mailing Address - State:TX
Mailing Address - Zip Code:75938-4412
Mailing Address - Country:US
Mailing Address - Phone:409-837-9298
Mailing Address - Fax:
Practice Address - Street 1:5037 FM 256 E
Practice Address - Street 2:
Practice Address - City:COLMESNEIL
Practice Address - State:TX
Practice Address - Zip Code:75938-4412
Practice Address - Country:US
Practice Address - Phone:409-837-9298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61696101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX61696OtherLPC