Provider Demographics
NPI:1104974294
Name:MILLER, BONNIE GAY (LPCC)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:GAY
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HOSPITAL LOOP NE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2128
Mailing Address - Country:US
Mailing Address - Phone:505-270-9458
Mailing Address - Fax:505-265-0799
Practice Address - Street 1:101 HOSPITAL LOOP NE
Practice Address - Street 2:SUITE 215
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2129
Practice Address - Country:US
Practice Address - Phone:505-270-9458
Practice Address - Fax:505-265-0799
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0088311101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional