Provider Demographics
NPI:1366206005
Name:BONILLA, LUIS RUBEN (LPC)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:RUBEN
Last Name:BONILLA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2229 W 16TH PL
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-5141
Mailing Address - Country:US
Mailing Address - Phone:928-581-0185
Mailing Address - Fax:
Practice Address - Street 1:2229 W 16TH PL
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-5141
Practice Address - Country:US
Practice Address - Phone:928-581-0185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-22781101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional