Provider Demographics
NPI:1932094737
Name:BONICELLI, ALEX (LPC-CANDIDATE)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:BONICELLI
Suffix:
Gender:F
Credentials:LPC-CANDIDATE
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:BONICELLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC-CANDIDATE
Mailing Address - Street 1:525 LIBERTY LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-9046
Mailing Address - Country:US
Mailing Address - Phone:405-726-8966
Mailing Address - Fax:
Practice Address - Street 1:525 LIBERTY LN
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-9046
Practice Address - Country:US
Practice Address - Phone:405-726-8966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health