Provider Demographics
NPI:1528082179
Name:MUCKLOW, BONNIE (LPC, LMFT, CAC III)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:MUCKLOW
Suffix:
Gender:F
Credentials:LPC, LMFT, CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 E BELLEVIEW AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1622
Mailing Address - Country:US
Mailing Address - Phone:720-488-3822
Mailing Address - Fax:303-798-3883
Practice Address - Street 1:7000 E BELLEVIEW AVE STE 203
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-1622
Practice Address - Country:US
Practice Address - Phone:720-488-3822
Practice Address - Fax:303-798-3883
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO149106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist