Provider Demographics
NPI:1063528966
Name:BONNEAUX, ALLISHA GAYLE SKINNER (MED,LPC)
Entity type:Individual
Prefix:
First Name:ALLISHA
Middle Name:GAYLE SKINNER
Last Name:BONNEAUX
Suffix:
Gender:F
Credentials:MED,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 FM 1130
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77632-3740
Mailing Address - Country:US
Mailing Address - Phone:409-988-4221
Mailing Address - Fax:
Practice Address - Street 1:7700 FM 1130
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77632-3740
Practice Address - Country:US
Practice Address - Phone:409-988-4221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14019101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168911901Medicaid