Provider Demographics
NPI:1699094094
Name:URLAUB, BONNIE LOU (MA, LPC)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:LOU
Last Name:URLAUB
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 W BALDWIN ST
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-3185
Mailing Address - Country:US
Mailing Address - Phone:989-358-2273
Mailing Address - Fax:989-340-1203
Practice Address - Street 1:442 W BALDWIN ST
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-3185
Practice Address - Country:US
Practice Address - Phone:989-358-2273
Practice Address - Fax:989-340-1203
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401001249101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional