| Doctor Name: | DR. BONNY ELIZABETH THACKER |
| NPI Number: | 1093051633 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSY.D. |
| License Number: | 2013006401 |
| Business Practice Address: | 704 E Highway 28 Owensville, MO - 650661588 |
| Business Phone Number: | 5734372959 |
| Business Fax Number: | |
| Mailing Address: | 180 Community, CLINTON |
| State: | MO |
| Postal Code: | 647358804 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 01/01/2013 |
| NPI Last Update Date: | 12/15/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TB0200X |
| License Number: | 2013006401 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Cognitive & Behavioral |
| Taxonomy Definition: | |