| Bon Creative Change, Llc | |
|
1400 Barbara Loop Se Ste H Rio Rancho NM 87124-1088 | |
| (505) 620-9785 | |
| Not Available |
| Full Name | Bon Creative Change, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 1400 Barbara Loop Se Ste H, Rio Rancho, New Mexico |
| Authorized Official Name and Position | Bonnie J Boucher (OWNER/DIRECTOR) |
| Authorized Official Contact | 5056209785 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bon Creative Change, Llc 11024 Montgomery Blvd Ne # 359 Albuquerque NM 87111-3962 Ph: (505) 620-9785 | Bon Creative Change, Llc 1400 Barbara Loop Se Ste H Rio Rancho NM 87124-1088 Ph: (505) 620-9785 |
| NPI Number | 1366954968 |
|---|---|
| Provider Enumeration Date | 11/04/2017 |
| Last Update Date | 01/24/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366954968 | NPI | - | NPPES |
| 0124121 | Other | NM | LPCC LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | O124121 (New Mexico) | Secondary |
| 101YP2500X | Counselor - Professional | 0124121 (New Mexico) | Primary |
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