| Doctor Name: | RICHARD CHARLES BONNEAU |
| NPI Number: | 1366712424 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | RASI RI-1007151243 |
| Business Practice Address: | 452 Old Mammoth Rd 3rd Floor Mammoth Lakes, CA - 93546 |
| Business Phone Number: | 7609241740 |
| Business Fax Number: | 7609241741 |
| Mailing Address: | Po.box 2619, MAMMOTH LAKES |
| State: | CA |
| Postal Code: | 935462619 |
| Phone Number: | 7609241740 |
| Fax Number: | 7609241741 |
| NPI Enumeration Date: | 01/06/2012 |
| NPI Last Update Date: | 01/06/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | RASI RI-1007151243 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |