Provider Demographics
NPI:1992292981
Name:SPICER, BONNIE KATHRYN (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:KATHRYN
Last Name:SPICER
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 STEAM MILL FERRY RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-1912
Mailing Address - Country:US
Mailing Address - Phone:731-660-6060
Mailing Address - Fax:
Practice Address - Street 1:165 BELLMEADE DRIVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-2202
Practice Address - Country:US
Practice Address - Phone:731-803-1447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-16
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5957101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health