| Doctor Name: | MRS. BONNIE M TUBBS |
| NPI Number: | 1164608832 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.ED. |
| License Number: | 122270 |
| Business Practice Address: | 1742 Cheryl St Clarksdale, MS - 386147218 |
| Business Phone Number: | 6626277267 |
| Business Fax Number: | 6626275240 |
| Mailing Address: | Po Box 331, CLARKSDALE |
| State: | MS |
| Postal Code: | 386140331 |
| Phone Number: | 6626277267 |
| Fax Number: | 6626275240 |
| NPI Enumeration Date: | 01/12/2008 |
| NPI Last Update Date: | 01/12/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 122270 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |