Provider Demographics
NPI:1104146489
Name:LINDSTROM, BONNELL K (LPC)
Entity type:Individual
Prefix:
First Name:BONNELL
Middle Name:K
Last Name:LINDSTROM
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 1:3211 W 20TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-6566
Mailing Address - Country:US
Mailing Address - Phone:970-356-3100
Mailing Address - Fax:970-356-4827
Practice Address - Street 1:3211 W 20TH ST STE D
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-6566
Practice Address - Country:US
Practice Address - Phone:970-356-3100
Practice Address - Fax:970-356-4827
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5671101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional