Provider Demographics
NPI:1285171306
Name:SCOTT, BONNIE (LPC)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:SCOTT
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 1:9610 LANTANA DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-4516
Mailing Address - Country:US
Mailing Address - Phone:210-544-7646
Mailing Address - Fax:
Practice Address - Street 1:12915 JONES MALTSBERGER RD STE 201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-4540
Practice Address - Country:US
Practice Address - Phone:210-544-7646
Practice Address - Fax:210-941-0602
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73442101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor