Provider Demographics
NPI:1154598126
Name:MORRIS MAISEN, BONNIE (CCS)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:
Last Name:MORRIS MAISEN
Suffix:
Gender:F
Credentials:CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 N 24TH ST
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-4344
Mailing Address - Country:US
Mailing Address - Phone:870-260-2052
Mailing Address - Fax:501-321-8202
Practice Address - Street 1:600 MAIN ST
Practice Address - Street 2:SUITE V
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-4905
Practice Address - Country:US
Practice Address - Phone:501-321-8200
Practice Address - Fax:501-620-7843
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator