Provider Demographics
NPI:1932752235
Name:RYE, BONNY (LLP)
Entity type:Individual
Prefix:
First Name:BONNY
Middle Name:
Last Name:RYE
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 SPRINGER WAY APT 1824
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8340
Mailing Address - Country:US
Mailing Address - Phone:810-441-1873
Mailing Address - Fax:
Practice Address - Street 1:4690 FULTON ST E STE 102
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-8454
Practice Address - Country:US
Practice Address - Phone:616-425-7701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361002652103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4394404Medicaid