Provider Demographics
NPI:1053934042
Name:TAYLOR, BONNI LIANE (LPC)
Entity type:Individual
Prefix:
First Name:BONNI
Middle Name:LIANE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9888 E VASSAR DR APT L209
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-5990
Mailing Address - Country:US
Mailing Address - Phone:571-224-3624
Mailing Address - Fax:
Practice Address - Street 1:2121 S ONEIDA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-2549
Practice Address - Country:US
Practice Address - Phone:571-224-3624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-25
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)