Doctor Name: | BONNIE SUE BLANZY |
NPI Number: | 1376641803 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA LPC |
License Number: | 6401007985 |
Business Practice Address: | 12850 Fountain Sq. Ste. 106 Davisburg, MI - 48350 |
Business Phone Number: | 2486346303 |
Business Fax Number: | 2486341746 |
Mailing Address: | 12850 Fountain Sq., Ste. 106 DAVISBURG |
State: | MI |
Postal Code: | 48350 |
Phone Number: | 2486346303 |
Fax Number: | 2486341746 |
NPI Enumeration Date: | 09/20/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 6401007985 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |