Provider Demographics
NPI:1114583853
Name:HOLMES, BONNIE L (LPC)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:L
Last Name:HOLMES
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 1:7033 E TUDOR RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1262
Mailing Address - Country:US
Mailing Address - Phone:907-729-8583
Mailing Address - Fax:907-729-5180
Practice Address - Street 1:3000 C ST STE 102
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3975
Practice Address - Country:US
Practice Address - Phone:907-729-8583
Practice Address - Fax:907-729-5180
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-17
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK104176101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1721232Medicaid