Provider Demographics
NPI:1194705665
Name:CHAVEZ, BONNIE ROBERTS (PHD)
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:ROBERTS
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NAVAL BRANCH HEALTH CLINIC
Mailing Address - Street 2:1801 FULLER RD. SUITE A-01 BLDG 367
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39309-0001
Mailing Address - Country:US
Mailing Address - Phone:601-679-3969
Mailing Address - Fax:
Practice Address - Street 1:NAVAL BRANCH HEALTH CLINIC
Practice Address - Street 2:1801 FULLER RD. SUITE A-01 BLDG 367
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39309-0001
Practice Address - Country:US
Practice Address - Phone:601-679-3969
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04083103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical