| Bonfire Healing | |
|
900 Ne 65th St Seattle WA 98115-5668 | |
| (561) 373-1310 | |
| Not Available |
| Full Name | Bonfire Healing |
|---|---|
| Speciality | Counselor |
| Location | 900 Ne 65th St, Seattle, Washington |
| Authorized Official Name and Position | Bonnie Deopp (OWNER) |
| Authorized Official Contact | 2066574242 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bonfire Healing 900 Ne 65th St Unit 506 Seattle WA 98115-5671 Ph: (206) 657-4242 | Bonfire Healing 900 Ne 65th St Seattle WA 98115-5668 Ph: (561) 373-1310 |
| NPI Number | 1508640053 |
|---|---|
| Provider Enumeration Date | 08/23/2023 |
| Last Update Date | 08/23/2023 |
| Certification Date | 08/23/2023 |
| Medicare PECOS PAC ID | 3173065299 |
|---|---|
| Medicare Enrollment ID | O20240604004390 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508640053 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 133NN1002X | Nutritionist - Nutrition, Education | (* (Not Available)) | Secondary |
| Provider Name | Bonnie Tollefson Deopp |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1760790331 PECOS PAC ID: 4082156104 Enrollment ID: I20240604004408 |
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