NPIMap

Organization Active NPI

Bon Creative Change, LLC

  • Professional Counselor
  • Rio Rancho, NM
National Provider Identifier
1366954968
Registry record updated Jan 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
0124121 Issued in NM
Legal business name
BON CREATIVE CHANGE, LLC
Practice address
1400 Barbara Loop SE Ste H
Rio Rancho, NM 87124-1088
Phone
(505) 620-9785
NPI assigned
Nov 4, 2017
Last updated
Jan 24, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Bonnie J Boucher, LPCCNPI 1548358583
Title
Owner/Director
Phone
(505) 620-9785

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X O124121 NM
Professional Counselor 101YP2500X 0124121 NM Primary

Addresses

Primary practice location

1400 Barbara Loop SE Ste H
Rio Rancho, NM 87124-1088

Mailing address

11024 Montgomery Blvd NE # 359
Albuquerque, NM 87111-3962
Phone (505) 620-9785

Other identifiers 1

IdentifierTypeStateIssuer
0124121OtherNMLPCC LICENSE

National Provider Directory

National Provider Directory

Locations

1400 Barbara Loop SE
Ste H
Rio Rancho, NM 87124
Phone (505) 261-3662

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1509753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516752000000",
    "number": "1366954968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11024 MONTGOMERY BLVD NE # 359",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871113962",
            "telephone_number": "505-620-9785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 BARBARA LOOP SE STE H",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871241088",
            "telephone_number": "505-620-9785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BON CREATIVE CHANGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-04",
        "last_updated": "2018-01-24",
        "status": "A",
        "authorized_official_last_name": "BOUCHER",
        "authorized_official_first_name": "BONNIE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "505-620-9785",
        "authorized_official_credential": "LPCC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NM",
            "license": "O124121",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NM",
            "license": "0124121",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LPCC LICENSE",
            "identifier": "0124121",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rio Rancho, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.