Provider Demographics
NPI:1538220181
Name:JUROE, BONITA GAYLON (MFT LCPC)
Entity type:Individual
Prefix:MRS
First Name:BONITA
Middle Name:GAYLON
Last Name:JUROE
Suffix:
Gender:F
Credentials:MFT LCPC
Other - Prefix:
Other - First Name:BONITA
Other - Middle Name:
Other - Last Name:BUZZELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5356
Mailing Address - Street 2:160 HERITAGE WAY
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901
Mailing Address - Country:US
Mailing Address - Phone:406-755-4495
Mailing Address - Fax:
Practice Address - Street 1:160 HERITAGE WAY
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901
Practice Address - Country:US
Practice Address - Phone:406-755-4495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT895LCPC101Y00000X
CA27880MFT106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT744283OtherBLUE CROSS BLUE SHIELD PI