Provider Demographics
NPI:1104946045
Name:BONTRAGER, B. KAY (LMHC, CADAC-II, MAC)
Entity type:Individual
Prefix:
First Name:B.
Middle Name:KAY
Last Name:BONTRAGER
Suffix:
Gender:F
Credentials:LMHC, CADAC-II, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-2964
Mailing Address - Country:US
Mailing Address - Phone:574-262-3231
Mailing Address - Fax:800-282-4819
Practice Address - Street 1:2921 GREENLEAF BLVD
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-4363
Practice Address - Country:US
Practice Address - Phone:574-575-0636
Practice Address - Fax:800-282-4819
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN501688101YA0400X
INC248101YA0400X
IN39000960A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health