Provider Demographics
NPI:1407646284
Name:LYKES, BONNIE
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:
Last Name:LYKES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13711 NW 56TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-2558
Mailing Address - Country:US
Mailing Address - Phone:352-575-3463
Mailing Address - Fax:
Practice Address - Street 1:5550 NW 111TH BLVD STE 108
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-9711
Practice Address - Country:US
Practice Address - Phone:352-575-3463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0528202401101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health