Provider Demographics
NPI:1194075234
Name:BONTRAGER, BEVERLY KAY (LCSW)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:KAY
Last Name:BONTRAGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 FROSTWOOD DR STE 670
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2415
Mailing Address - Country:US
Mailing Address - Phone:713-858-3221
Mailing Address - Fax:
Practice Address - Street 1:920 FROSTWOOD DR STE 670
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2415
Practice Address - Country:US
Practice Address - Phone:713-858-3221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX532011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical